ISOLATED TOXOPLASMOSIS OF THE THORACIC SPINAL-CORD IN A PATIENT WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Toxoplasmosis and lymphoma are the two most common causes of intrapare nchymal cerebral mass lesions in patients with acquired immunodeficien cy syndrome (AIDS). The clinical and radiographic features of the intr acranial lesions have been well described. Because of the high frequen cy of toxoplasmosis in the AIDS population, common therapy for patient s presenting with intracranial mass lesions consists of an empirical t rial of anti-Toxoplasma chemotherapy, with biopsy reserved for cases d emonstrating features considered to be more consistent with lymphoma, or for lesions that do not improve despite adequate anti-Toxoplasma tr eatment. A similar treatment algorithm does not exist for intramedulla ry lesions of the spinal cord. The authors describe a patient who pres ented with paraparesis resulting from an isolated thoracic intramedull ary lesion. An open biopsy of the lesion revealed characteristic struc tures containing Toxoplasma tachyzoites. The clinical and radiographic presentation of the lesion is discussed, the available literature is reviewed, and a treatment strategy for spinal cord lesions in AIDS pat ients is proposed.