World Neurosurg 2019 Apr 11. Epub 2019 Apr 11.
Department of Neurosurgery, Santa Clara Valley Medical Center, San Jose, CA 95128; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305. Electronic address:
Background: Neurological complications are common in HIV/AIDS patients. While both the central nervous system (CNS) and the peripheral nervous system (PNS) can be affected, up to 80% of HIV/AIDS patients have CNS involvement during the course of their illness. The brain is the primary site of HIV/AIDS associated CNS complications. Spinal cord involvement is rare, particularly focal intramedullary spinal cord lesions without any associated cerebral lesions. Amongst various opportunistic infections and malignancies, toxoplasmosis and CNS lymphoma represent the most common cause of focal neurological disease in HIV/AIDS patients. However, distinguishing between toxoplasmosis and CNS lymphoma is challenging as both diseases have similar clinical presentations.
Case Description: This report demonstrates a case of myelopathy presenting as an isolated, single intramedullary spinal cord lesion in a newly diagnosed HIV positive female. Additionally, we discuss common methods of diagnostic distinction between the toxoplasmosis and CNS lymphoma.
Conclusion: We suggest that there should be a high-index of suspicion for toxoplasmosis in HIV/AIDS patients presenting with a focal intramedullary spinal cord lesion.