Spinal cord toxoplasmosis as an unusual presentation of AIDS: case report and review of the literature

Abstract

Approximately 10% of patients with AIDS present with some neurological deficit as their initial complaint, and up to 80% will have CNS involvement during the course of their disease. Toxoplasmosis is the most common cause of cerebral mass lesions in patients with AIDS, but appears to be an uncommon cause of spinal cord disease. The incidence of myelopathy may be as high as 20%, with 50% of the cases reported post-mortem. We present a unique case of spinal cord disease as the initial presentation of AIDS. We also present a comprehensive literature review of this topic, its diagnosis and treatment. This is a retrospective chart review case report. After a detailed case presentation, several diagnostic and therapeutic aspects of this unique case are thoroughly discussed. Although spinal cord toxoplasmosis is uncommon, it has been suggested that most patients with AIDS that present with evolving myelopathy, characterized by extremity weakness, sensory involvement, spinal cord enlargement, enhancing lesions in brain or spinal cord CT or MRI, have toxoplasmic myelitis.

Cerebral Toxoplasmosis Mimicking Subacute Meningitis in HIV-Infected Patients; a Cohort Study from Indonesia

“…In previous series of cerebral toxoplasmosis [18], [19], meningeal signs have been reported in 3 to 16% of the patients, although in many reports neck stiffness is not mentioned [14]. Although rare, cases of spinal cord toxoplasmosis have also been reported [20]. No typical mass lesions were found in 6 patients with an available CT scan.…”

Toxoplasmosis intramedular en una paciente con coinfección por VIH y tuberculosis

“…El diagnóstico definitivo de toxoplasmosis por la demostración del microorganismo en el estudio histopatológico está reservado para aquellos pacientes en quienes no se evidencia respuesta a la terapia antiparasitaria 9 . En relación al tratamiento de la toxoplasmosis intramedular, no existen estudios que avalen un fármaco determinado; sin embargo, la mayoría de los casos fueron tratados con buenos resultados con esquemas para encefalitis por Toxoplasma 5,11 ; siendo, pirimetamina-sulfadiazina (con ácido folínico) la terapia utilizada en la mayoría de los reportes. En la seguridad social de Perú, no disponemos de pirimetamina, considerada el régimen de elección, por lo que nuestra paciente fue tratada con cotrimoxazol (5 mg/kg de trimetoprim, fraccionado cada 12 h), según las recomendaciones internacionales 9 y basado en que no se ha demostrado diferencia entre ambos esquemas de tratamiento en encefalitis por Toxoplasma 12,13 .…”

Cervical Spinal Cord Toxoplasmosis in a Patient with AIDS: Case Report and Review of the Literature

“…It is considered as a very common cause of intracranial abscesses in HIV/AIDS patients but appears to be an infrequent cause of spinal cord disease [4]. The incidence of Toxoplasmosis in adult in USA range from 20%-70%, the two major routes of transmission of Toxoplasmosis to humans are oral and congenital [5]. A literature review mentions that although Toxoplasmosis is infrequent, it have to be suspected in immunocompromised patients who present with symptoms of acute or sub-acute myelopathy [4].…”

“…Toxoplasma gondii can be found in up to 50% of the world population [3]. Approximately 10% of patients with Acquired Immune Deficiency Syndrome (AIDS) show some kind of neurological deficit as their primary complaint, and around 80% will have Central Nervous System (CNS) involvement during the course of their illness [1,4,5]. The retina and the lungs are the major sites of extracerebral manifestation of Toxoplasmosis, and such manifestations may happen with/without concomitant Encephalitis [1].…”