title: Toxoplasmosis myelopathy and myopathy in an AIDS patient: a case of immune reconstitution inflammatory syndrome?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Departments of Neurology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Doris Hichi
authors.initials: DH
authors.lastname: Kung
authors.forename: Erica A
authors.initials: EA
authors.lastname: Hubenthal
authors.forename: Justin Y
authors.initials: JY
authors.lastname: Kwan
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Shelburne
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Goodman
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Kass
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D014123:Toxoplasmosis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D016896:Treatment Outcome