Spinal cord toxoplasmosis

Excerpt

A 54-year-old male was referred to our department for a monoparesis of his right arm. Blood tests revealed an infection with the human immunodeficiency virus (HIV), with low CD4+ T lymphocyte count (164 cells/mm³). The spinal cord magnetic resonance imaging (MRI) displayed an inflammatory infiltration without clear limits (Fig. 1a), with a surrounding edema (Fig. 2a). Given the patient’s underlying disease and the aspect of the images, a non-Hodgkin lymphoma was suspected and an 18-FDG positron emission tomography (PET) was performed in order to find an easier site for a biopsy. The PET scan revealed a unique hypermetabolic fixation (SUV max: 8) of the cervical spinal cord lesion (Fig. 2b). The co-registration either with computed tomography (CT) or MRI scans showed a perfect co-localisation of the tumour and the increased 18-FDG uptake (Figs. 1b, c and 2c). A surgical biopsy was performed at this level. The histological analysis excluded a lymphoma but revealed the presence of Toxoplasma tachyzoites. The polymerase chain reaction (PCR) for Toxoplasma gondii performed on the spinal cord biopsy was positive. A treatment for toxoplasmosis was started and the patient slowly recovered.

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