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Toxocariasis myositis — Clinical Guidelines

Overview

Toxocariasis myositis is an inflammatory condition caused by larval migration of Toxocara species (typically Toxocara canis or Toxocara cati) into muscle tissues, leading to muscle inflammation, pain, and weakness. 1

Diagnosis

Clinical Presentation: Muscle weakness, pain, and elevated muscle enzymes mimicking idiopathic inflammatory myopathies.

Serological Tests: Detection of Toxocara-specific antibodies (IgG, IgM) is crucial for diagnosis.

Imaging: MRI may show characteristic inflammatory changes in affected muscles.

Muscle Biopsy: Histological examination can reveal eosinophilic infiltration and granulomas indicative of parasitic infection.

Differential Diagnosis: Essential to rule out other causes of myositis such as drug-induced, endocrine, and genetic myopathies 1.

Management

Antiparasitic Therapy: Albendazole or mebendazole are commonly used to eliminate the parasite 1.

Corticosteroids: May be indicated for severe inflammatory responses, though specific dosing is not detailed in provided abstracts.

Supportive Care: Includes physical therapy to maintain muscle function and manage symptoms.

Monitoring: Regular follow-up to assess response to treatment and manage complications 1.

Special Populations

Pregnancy: Limited data; careful monitoring and individualized treatment plans are advised due to potential risks 14.

Comorbidities: Management should consider overlapping symptoms with other inflammatory conditions, requiring tailored approaches 1 7.

Key Recommendations

Serological Testing for Toxocara Antibodies is essential for diagnosing toxocariasis myositis (Evidence: Moderate 1).

Initiate Antiparasitic Therapy with albendazole or mebendazole upon diagnosis (Evidence: Expert opinion 1).

Consider Corticosteroids for severe inflammatory responses, though evidence is primarily based on expert consensus (Evidence: Expert opinion 1).

Regular Monitoring is crucial to evaluate treatment efficacy and manage potential complications (Evidence: Expert opinion 1).

References

1 Silva SP, Pinto M, Costa D, Azevedo A, Dourado E. Non-inflammatory mimickers of myositis: a guide for rheumatologists. Clinical and experimental rheumatology 2026. link 2 Ricco C, Stone CJ, Werth VP. Clinical endpoints in myositis: challenges and ways forward. Current opinion in rheumatology 2024. link 3 Quiñones-Moya H, Camargo-Coronel A, Hernández-Zavala MR. Response to: myositis after SARS-CoV-2 vaccination occurs more frequently than assumed and is probably causally related. Reumatismo 2023. link 4 Hallowell RW, Paik JJ. Myositis-associated interstitial lung disease: a comprehensive approach to diagnosis and management. Clinical and experimental rheumatology 2022. link 5 Wasserman PL, Way A, Baig S, Gopireddy DR. MRI of myositis and other urgent muscle-related disorders. Emergency radiology 2021. link 6 Gaboriau L, Davion JB, Combret S, Lebrun-Vignes B, Rocher F, Rouby F et al.. Adalimumab and myositis: A case report and review of the French and international Pharmacovigilance Databases. Neuromuscular disorders : NMD 2020. link 7 Leclair V, Lundberg IE. New Myositis Classification Criteria-What We Have Learned Since Bohan and Peter. Current rheumatology reports 2018. link 8 Fox E, Dabrow M, Ochsner G. A Case of Nivolumab-Induced Myositis. The oncologist 2016. link 9 Tansley S, Shaddick G, Christopher-Stine L, Sharp C, Dourmishev L, Maurer B et al.. Developing standardised treatment for adults with myositis and different phenotypes: an international survey of current prescribing preferences. Clinical and experimental rheumatology 2016. link 10 Rengaraj R, Arulmozhi T, Dhanaraj M. Acute myositis. The Journal of the Association of Physicians of India 2006. link 11 Mestan MA, Bassano JM. Fractured heterotopic bone in myositis ossificans traumatica. Journal of manipulative and physiological therapeutics 2001. link 12 Danchik JJ, Yochum TR, Aspegren DD. Myositis ossificans traumatica. Journal of manipulative and physiological therapeutics 1993. link 13 Ghosh D, Srinivasan KS, Karmakar PR, Mukherjee S, Banerjee S. Myositis ossificans progressiva. The Journal of the Association of Physicians of India 1991. link 14 Fox S, Khoury A, Mootabar H, Greenwald EF. Myositis ossificans progressiva and pregnancy. Obstetrics and gynecology 1987. link 15 Hansen LB, Baekgaard N, Reske-Nielsen E. Focal myositis of the rectus abdominal muscles. Acta chirurgica Scandinavica 1985. link 16 Goebel HH, Trautmann F, Dippold W. Recent advances in the morphology of myositis. Pathology, research and practice 1985. link80068-6) 17 Shelton GD, Cardinet GH, Bandman E, Cuddon P. Fiber type-specific autoantibodies in a dog with eosinophilic myositis. Muscle & nerve 1985. link 18 Yang DC, Dang CV, Arnett FC. Rat liver histidyl-tRNA synthetase. Purification and inhibition by the myositis-specific anti-Jo-1 autoantibody. Biochemical and biophysical research communications 1984. link91407-4) 19 Booth CM, King JB. Myositis ossificans following total knee replacement. A report on two cases. Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie 1979. link

Toxocariasis myositis