POLYNEURITIS AND MYOSITIS IN AFRICAN TRYP ANOSOMIASIS

During a four-week trip to Nigeria a 54-year-old German developed a fe ver of 39 degrees C. Later on he had lymphadenopathy, pretibial oedema , dyspnoea and weight loss. After 16 weeks a wreath-like pale pink ski n rash, increased pulse rate with pulse deficit and hepatosplenomegaly were noted. Abnormal laboratory findings were an increased blood sedi mentation rate (95 mm), raised immunoglobulin M (483 mg/dl), haemoglob in of 12.0 g/dl, mean corpuscular volume of 76 fl and Borrelia IgM ant ibody titre of 1:512. The electrocardiogram was suggestive of myocardi tis: the cardiac symptoms were controlled with digoxin and verapamil. The patient's general con-g dition deteriorated while he was receiving antibiotic treatment with tetracyclin and penicillin. Cerebrospinal f luid (CSF) showed an increased cell count (39/mu l) and albumin (0.98 g/ dl). There was a mild, predominantly proximal, tetraplegia which - on the basis of electromyographic and biopsy findings - was thought to be due to polyneuritis and myositis. At this stage blood smear and CS F examination revealed Trypanosoma. He thereupon received suramin (1.0 g) and prednisolone (120 mg down to 40 mg) daily, to which melarsopro l was added after 6 days (0.5 ml up to 5.0 ml daily for 36 days). Almo st all symptoms then regressed within 6 weeks.