Fulminant toxoplasmosis presenting as isolated myelitis

A 29-year-old male patient with an untreated HIV infection for seven years presented with a two-month history of neck pain, progressive left-hand weakness and numbness. Physical examination showed C5-C6 territory hypoesthesia and urinary bladder retention. A spinal MRI showed a single contrast-enhanced lesion at C4-C6 level, cerebrospinal fluid analysis showed 3.6 white blood cells-mm3 and a positive IgG for toxoplasma. Despite empiric treatment, the disease progressed locally and to the brainstem. Autopsy showed disseminated CNS toxoplasmosis. Toxoplasmosis is the most common CNS infection in patients with AIDS, but isolated spinal cord involvement is rare. Prompt empiric treatment for toxoplasmosis should be considered in all patients.