Toxoplasmosis myelopathy and myopathy in an AIDS patient: A case of immune reconstitution inflammatory syndrome?

Doris Hichi Kung, Erica A. Hubenthal, Justin Y. Kwan, Samuel Shelburne, Jerry C. Goodman, Joseph S. Kass

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Introduction: Concurrent toxoplasmosis infection of the brain, spinal cord, and muscle has never been reported together in a patient antemortem. Toxoplasma gondii is the most common focal central nervous system opportunistic infection in the acquired immune deficiency syndrome (AIDS) population. Despite this fact, isolated toxoplasmosis infection in the spinal cord is rarely reported. In addition, toxoplasmic myositis is also rarely diagnosed and Toxoplasma cysts are seldom found on biopsy. We present a patient with AIDS and toxoplasmosis resistant to standard anti-Toxoplasma therapy. CASE Report: A 34-year-old man with a history of untreated AIDS presented with symptoms of myelopathy. Pathologically proven toxoplasmosis of the spinal cord was diagnosed and no brain lesions were found. However, despite appropriate treatment and initiation of highly active antiretroviral therapy, the patient developed worsening symptoms, including myopathy and autonomic instability. Muscle biopsy revealed Toxoplasma cysts, and there was laboratory evidence of a restored immune system. Conclusion: We report the first case of toxoplasmosis presenting initially with myelitis in the absence of encephalitis that subsequently progressed to myositis despite antiparasitic treatment. We also discuss the possibility of immune reconstitution inflammatory syndrome as a cause of his deterioration.

Original languageEnglish (US)
Pages (from-to)49-51
Number of pages3
JournalNeurologist
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2011

Keywords

  • AIDS
  • IRIS
  • myelitis
  • myostis
  • Toxoplasmosis

ASJC Scopus subject areas

  • Clinical Neurology

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