SEVERE TOXOPLASMIC VENTRICULOMENINGOENCEPHALOMYELITIS IN 2 AIDS PATIENTS FOLLOWING TREATMENT OF CEREBRAL TOXOPLASMIC GRANULOMA

Two patients with acquired immunodeficiency syndrome (AIDS) who were s uccessfully treated for cerebral toxoplasmosis presented a few weeks l ater with neurologic abnormalities. Brain CT scan showed ventricular d ilatation, ependymitis, and meningoencephalitis. Both patients died de spite extensive treatment. Neuropathological examination showed enlarg ement of the cerebral ventricles, severe ventriculoencephalitis with l arge ependymal and subependymal necrosis, and numerous pseudomembranes within the ventricle lumen. Microscopic examination revealed severe n ecrotizing ventriculoencephalitis, meningoencephalitis and myelitis. I mmunohistochemical studies revealed the presence of miriads of tachyzo ites within and around the necrotic areas. Such form of toxoplasmosis as a diffuse meningo-encephalo-ventriculo-myelitis appear unique to AI DS and, to our knowledge, have not been previously documented.