Abstract 16403: Toxoplasma Cardiomyopathy in a 36 Year HIV Positive Female

Introduction: Cardiac involvement of toxoplasmosis is extremely rare and can present as myocarditis, pericardial effusion, constrictive pericarditis, arrhythmias or heart failure. While acquired primary infection is severe in immunocompetent, it can be life-threatening among immunodeficient patients.

Case: 36 Yr female with PMHx of HIV non-compliant with HAART, Toxoplasma infection in 2019 presented with weakness, dry cough & substernal chest pain x 1-week, sharp type, increasing with lying flat. On presentation vitals were unremarkable. ECG showed diffuse T wave inversions. Troponins elevated at 5000s. MRI brain revealed multiple scattered bilateral cortical and cerebellar enhancing lesion suggestive of toxoplasmosis. Serology was positive for toxoplasmosis. Viral respiratory panel & Sepsis work-up was negative. TTE on admission showed mild pericardial effusion and EF of 50-55%. Follow up TTE (day 7) revealed an EF of 25-30% with mild pericardial effusion pointing towards a toxoplasma induced myopericarditis leading to cardiomyopathy. TEE ruled out possibility of Endocarditis.

Discussion: Patient was initiated on anti-toxoplasma therapy with pyrimethamine and sulfadiazine after toxoplasma cardiomyopathy was considered. After initial cardiopulmonary decompensation patient was intubated and needed pressor support. Over the course of next 2 weeks her condition improved with anti-toxoplasma therapy and was extubated.

Conclusion: Toxoplasma myopericarditis is rare and a serious presentation among both immunocompetent and immunodeficient patients. Early intervention and diagnosis of Toxoplasma myopericarditis could prevent the progression of cardiomyopathy and improve overall prognosis.