Disclosures: Bethany A. Calabrese, DO: Nothing to disclose

Case Description: The patient presented with progressive bilateral lower extremity weakness, inability to ambulate, numbness, and urinary retention. Upon examination he displayed right greater than left lower extremity weakness and saddle anesthesia. He also had urinary retention requiring Foley catheter placement. Magnetic resonance imaging of his brain and spine revealed numerous focal hyperintense lesions with enhancement throughout the brain and entire spinal cord with increased involvement of the cervical and thoracic spine. Cerebrospinal fluid analysis was positive for Toxoplasma gondii and confirmed a diagnosis of central nervous system toxoplasmosis. Infectious Disease recommended Pyrimethamine, Sulfadiazine, Leucovorin, and Dexamethasone with resumption of HAART. CD4 count was 327. He was transferred to the IRF for rehabilitation.

Setting: Academic Center with Acute Inpatient Rehabilitation Facility (IRF).

Patient: 43-year-old male with human immunodeficiency virus (HIV) who was noncompliant with highly active antiretroviral therapy (HAART).

Assessment/Results: On admission, he was diagnosed as T10 AIS (American Spinal Injury Association [ASIA] Impairment Scale) D and showed improvement in strength with return to ambulation. His total functional independence measure (FIM) improved from 46 on IRF admission to 96 on IRF discharge.

Discussion: Spinal cord pathology in HIV patients is uncommon and most often secondary to vacuolar myelopathy. This is an unusual case of toxoplasmosis involving the spinal cord. Although this patient with HAART noncompliance presented with significant impairment and findings of myelopathy secondary to toxoplasmic myelitis, he had significant improvement in FIM score during his IRF admission. The only basis of comparison for functional improvement is a case report of toxoplasmosis encephalitis where the total FIM change was significantly less with acquired immune deficiency syndrome.

Conclusion: Toxoplasmic myelitis should be considered in HIV positive patients presenting with acute findings of myelopathy. Following appropriate acute management, a formal course of acute inpatient rehabilitation has been shown to improve functional outcomes.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/toxoplasmic-myelitis-in-a-hiv-positive-patient-noncompliant-with-haart-a-case-report/