Toxoplasma Pericarditis in an Immunocompetent Child- A Rare Case Report

Abstract

Toxoplasmosis is a parasitic infection caused by the protozoan, Toxoplasma gondii which is an obligate intracellular parasite. Among all the parasites known to cause myocarditis or pericarditis, the most commonly found is Chaga’s Disease or American Trypanosomiasis. Several other parasites including T. gondii can affect the heart in immunocompromised patients. Individuals with intact immunity largely remain asymptomatic. Only 22 cases of Toxoplasma Pericarditis have been reported worldwide. Although, CNS and Ocular Toxoplasmosis cases have been reported from Indian subcontinent, there is a lack of literature on cardiac involvement by Toxoplasma. Here, we present a case of a   11 yr old immunocompetent child with Toxoplasma Pericarditis, the first case to be reported from India. An echocardiography confirmed diagnosis of pericardial effusion for which pericardiocentesis was done and sent to our department for cytological evaluation. Fluid was exudative with pericardial fluid to serum protein ratio of 0.7. Gram stain, AFB stain and CB NAAT of pericardial fluid were negative. Cytology revealed neutrophils and macrophages showing presence of intracellular organisms resembling tachyzoites of Toxoplasma species on the Giemsa stained smear. These tachyzoites were crescent shaped with one pointed end and the other rounded end and a central nuclei. A final diagnosis of Toxoplasma Pericarditis was made based on microscopy findings.  T. gondii serological tests were also done which showed positivity for IgG with strong avidity. Thus, our case report represents an important differential that should be considered by all the clinicians in cases of acute pericarditis, especially in difficult cases where no other cause can be identified.