Document Detail


Toxoplasmosis myelopathy and myopathy in an AIDS patient: a case of immune reconstitution inflammatory syndrome?
MedLine Citation:
PMID:  21192196     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Doris Hichi Kung; Erica A Hubenthal; Justin Y Kwan; Samuel A Shelburne; Jerry C Goodman; Joseph S Kass
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The neurologist     Volume:  17     ISSN:  1074-7931     ISO Abbreviation:  Neurologist     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9503763     Medline TA:  Neurologist     Country:  United States    
Other Details:
Languages:  eng     Pagination:  49-51     Citation Subset:  IM    
Affiliation:
Departments of Neurology, Baylor College of Medicine, Houston, Texas, USA.
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