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[Spinal cord toxoplasmosis and AIDS]

M Carteret¹, E Petit, O Granat

¹Service de Radiologie, Hôpital Saint-Joseph, Paris.

Journal De Radiologie

|July 1, 1995

Summary

Toxoplasmosis, a common brain infection in AIDS patients, can also affect the spinal cord. Early MRI diagnosis and treatment are crucial for managing this rare but serious complication.

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Area of Science:

Neurology
Infectious Diseases
Radiology

Background:

Toxoplasmosis is the most frequent parasitic brain infection in individuals with acquired immunodeficiency syndrome (AIDS).
Spinal cord involvement in toxoplasmosis is rare, with limited documented cases, often associated with concurrent cerebral lesions.
This study presents a unique case of concurrent spinal cord and cerebral toxoplasmosis in an AIDS patient.

Observation:

Magnetic Resonance (MR) imaging revealed a focal enlargement of the conus medullaris, appearing iso intense on T1 and hyperintense on T2 weighted sequences.
The lesion demonstrated homogeneous enhancement post-Gadolinium contrast administration, accompanied by medullary edema.
Clinical improvement was observed following treatment initiation, with follow-up MR imaging showing normalization of the conus medullaris and resolution of enhancement.

Findings:

The case highlights the potential for toxoplasmosis to manifest as a single spinal cord lesion, even without apparent cerebral involvement.
MR imaging is a valuable tool for diagnosing spinal cord toxoplasmosis, showing characteristic features of inflammation and enhancement.
Prompt treatment without corticosteroids led to significant clinical and radiological improvement.

Implications:

Spinal cord lesions in AIDS patients, whether isolated or associated with brain involvement, should be presumed to be toxoplasmosis.
MR imaging follow-up is recommended to monitor treatment response and avoid unnecessary invasive procedures like medullary biopsy.
Cerebral toxoplasmosis lesions can sometimes mask or overshadow concurrent spinal cord involvement, emphasizing the need for comprehensive diagnostic evaluation.

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