Hospital Practices and Research

A Case of Toxoplasmosis Mimicking Influenza and COVID-19: Diagnostic Pitfalls and Management Challenges

Document Type : Case Report

Authors

Faride Khanabadi 1
Farnood Ghanoon 2
Hossein Torkashvand 3
Mohammadhossein Asadidarbaghi 4
Bahareh Basirpour 3
Mahdi Mosayebi 1
Seyedeh Shaghayegh Hosseini 2
Taher Elmi 1

1 Department of Parasitology and Mycology, School of Medicine, Arak University of Medical Sciences, Arak, Iran

2 Department of Laboratory Sciences, Babol Branch, Islamic Azad University, Babol, Iran

3 Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

4 Department of Radiology, Diagnostic Radiologist, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30491/hpr.2025.505690.1469
Abstract
Background: Toxoplasmosis, caused by Toxoplasma gondii, is a globally prevalent parasitic infection that often presents with nonspecific symptoms, making diagnosis challenging, especially in immunocompetent individuals.
Case Presentation: We report a case of a 22-year-old immunocompetent male presenting with cervical lymphadenopathy, fever, and flu-like symptoms, initially misdiagnosed as influenza or COVID-19. Despite symptomatic treatment, his condition worsened. Serological testing confirmed acute toxoplasmosis (IgM: 6.64 IU/ml; IgG: 44 IU/ml). Ultrasonography showed hypoechoic cervical lymph nodes, consistent with lymphadenopathy. Treatment with azithromycin, pyrimethamine, and folinic acid for 10 days led to complete symptom resolution.
Conclusion: This case highlights the importance of considering toxoplasmosis in the differential diagnosis of cervical lymphadenopathy, especially in patients with persistent flu-like symptoms. Early serological testing and imaging are crucial for accurate diagnosis and timely intervention. The rapid clinical improvement observed underscores the effectiveness of antiparasitic therapy in immunocompetent individuals. Greater clinician awareness of the diverse presentations of toxoplasmosis is essential to prevent misdiagnosis and optimize patient outcomes.

Keywords

Toxoplasmosis
Cervical lymphadenopathy
Toxoplasma gondii
Immunocompetent host
Azithromycin
Pyrimethamine
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Hospital Practices and Research
Volume 9, Issue 3 - Serial Number 35
Summer 2024
Pages 538-541

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