Toxoplasmosis of spinal cord in acquired immunodeficiency syndrome patient presenting as paraparesis: A rare entity

Background: Myelitis post Herpes-Zoster is a rare condition that is typically associated with immunocompromised states. It usually starts as an acute loss of sensory and motor functions below the affected spinal cord level. The condition can range in severity from a mild to a fatal presentation. Other neurological complications include meningitis, atypical presentations should encourage the search for undiagnosed immunosuppression states. The Case: We describe the case of a 42-year-old man, previously undiagnosed with HIV, who developed acute myelitis and meningitis after the appearance of the classic zoster lesions. On lumbar puncture and subsequent CSF analysis, the patient was found to have Froin’s Syndrome. The patient was initiated with ceftriaxone, vancomycin, and acyclovir regimen and prophylactic antiphymic treatment was also added. After 14 days in the hospital, the fever, headache, and neck stiffness subsided while the sphincter function and lower limb paraplegia did not improve. Conclusion: Varicella zoster virus reactivation suggests underlying immunosuppression. This case demonstrates the importance of being cognizant to the wide range of clinical manifestations that may suggest spinal cord involvement after clinical reactivation. Furthermore, physicians also need to be mindful that Acquired Immunodeficiency Syndrome (AIDS) and other immunodeficiency states could present with atypical clinical manifestations.

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Isolated toxoplasmosis of the thoracic spinal cord in a patient with acquired immunodeficiency syndrome

Journal of Neurosurgery ◽

10.3171/jns.1995.82.3.0493 ◽

1995 ◽

Vol 82 (3) ◽

pp. 493-496 ◽

Cited By ~ 11

Author(s):

Daniel K. Resnick ◽

Christopher H. Comey ◽

William C. Welch ◽

A. Julio Martinez ◽

William W. Hoover ◽

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Keyword(s):

Spinal Cord ◽

Acquired Immunodeficiency Syndrome ◽

Treatment Algorithm ◽

Thoracic Spinal Cord ◽

Similar Treatment ◽

Content Type ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Mass Lesions ◽

Fine Print

✓ Toxoplasmosis and lymphoma are the two most common causes of intraparenchymal cerebral mass lesions in patients with acquired immunodeficiency syndrome (AIDS). The clinical and radiographic features of the intracranial lesions have been well described. Because of the high frequency of toxoplasmosis in the AIDS population, common therapy for patients presenting with intracranial mass lesions consists of an empirical trial of anti-Toxoplasma chemotherapy, with biopsy reserved for cases demonstrating features considered to be more consistent with lymphoma, or for lesions that do not improve despite adequate anti-Toxoplasma treatment. A similar treatment algorithm does not exist for intramedullary lesions of the spinal cord. The authors describe a patient who presented with paraparesis resulting from an isolated thoracic intramedullary lesion. An open biopsy of the lesion revealed characteristic structures containing Toxoplasma tachyzoites. The clinical and radiographic presentation of the lesion is discussed, the available literature is reviewed, and a treatment strategy for spinal cord lesions in AIDS patients is proposed.

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Septate fungal invasion in masked mastoiditis: a diagnostic dilemma

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000326 ◽

2006 ◽

Vol 120 (3) ◽

pp. 250-252 ◽

Cited By ~ 7

Author(s):

G Kuruvilla ◽

A Job ◽

J Mathew ◽

A P Ayyappan ◽

M Jacob

Keyword(s):

Diabetic Patient ◽

Acquired Immunodeficiency Syndrome ◽

Literature Search ◽

English Literature ◽

Diabetic Patients ◽

Rare Entity ◽

Diagnostic Dilemma ◽

First Case ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Invasive fungal mastoiditis is a rare entity, seen almost entirely in immunocompromized patients. It has been reported primarily in patients with leukaemia and more recently with acquired immunodeficiency syndrome. A literature search revealed only a few reports in diabetic patients, in whom the invasive fungus was identified as mucormycosis in all cases. We report the first case in the English literature of invasive septate fungal mastoiditis in a diabetic patient with intact tympanic membranes.

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