[Spinal cord toxoplasmosis and AIDS]

Toxoplasmosis is the most common brain parasitic infection in acquired immunodeficiency syndrome (AIDS). Spinal cord localisations are still rare (2 cases with cerebral involvement, 2 cases without). A case of both spinal cord and cerebral involvement is reported. MR imaging was performed because of sensory level (L1). A focal conus medullaris enlargement was seen, iso intense on T1 weighted images. This lesion was hyperintense on T2 weighted sequence, and was homogeneously enhanced after Gadolinium on T1 weighted images. A medullary oedema was noted. A toxoplasmosis treatment was initiated, without corticotherapy. MR imaging performed one month later (D30), while important clinical improvements were seen, pointed out normal thickness of conus medullaris, without enhancement after Gadolinium. Disease lesions in AIDS with focal spinal cord processes are reviewed, and diagnostic work-up is discussed. Spinal cord single lesion, associated or not with brain involvements should be treated as a toxoplasmic infection, with MR imaging follow up. This work up should avoid medullary biopsy, still required in case of treatment failure. Cerebral involvements, with multiples lesions, can mask medullary localisation.