Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Apr-Jun;21(2):161-163.
doi: 10.4103/aian.AIAN_387_17.

Longitudinally Extensive Transverse Myelitis Due to Toxoplasma: An Autopsy Study

Yareeda Sireesha  1 , Megha S Uppin  2 , Komal Bohra  1 , Rajesh Alugolu  3 , Mathukumalli L Neeharika  1 , Angamuthu Kanikannan  1
Affiliations
Case Reports

Longitudinally Extensive Transverse Myelitis Due to Toxoplasma: An Autopsy Study

Yareeda Sireesha et al. Ann Indian Acad Neurol. 2018 Apr-Jun.

Abstract

Toxoplasma is an obligate intracellular parasite that remains asymptomatic in humans but, at times, can cause devastating disease. Here, we describe an autopsy study of a young immunocompetent gentleman with no comorbidities whose presentation was acute transverse myelitis. Magnetic resonance imaging spine showed longitudinally extensive spinal cord lesion (LESCL) that mimicked neuromyelitis optica with normal brain imaging at presentation. Investigations showed albuminocytological dissociation which prompted a course of parenteral steroid. However, the lesion relentlessly progressed to involve the brain stem and cerebrum leading to toxoplasmic encephalitis that terminated fatally. This report highlights that toxoplasma can present as LESCL and needs to be considered in the differential diagnosis of atypical myelitis.

Keywords: Autopsy study; immunocompetent adult; longitudinally extensive; myelitis; toxoplasma.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Magnetic resonance imaging of cervical spine showed longitudinal hyperintensity involving C1–C5 segments, with normal brain parenchyma
Figure 2
Figure 2
Magnetic resonance imaging brain-fluid-attenuated inversion recovery and contrast sequences showing heterogeneous lesion with surrounding edema in the region of basal ganglia, internal capsule, and midbrain. The margins of the lesion showed enhancement on contrast administration
Figure 3
Figure 3
Gross examination of brain showing (a) large area of necrosis involving the right basal ganglia extending to periventricular white matter, (b) completely necrotic midbrain and (c) pituitary gland, (d) a small focus of necrosis with spinal cord
Figure 4
Figure 4
Microscopic sections from brain showing (a) necrosis with collections of neutrophils (H and E, ×40), (b) vessel wall necrosis with perivascular aggregates of histiocytes (H and E, ×40), (c) bradyzoites of toxoplasma (arrowhead) (H and E, ×40), (d) histiocytes with intracytoplasmic tachyzoites (H and E, ×100), (e) toxoplasma cyst, and (f) immunohistochemical positivity of tachyzoites for toxoplasma antibody
See this image and copyright information in PMC

References

    1. Pandit L. Neuromyelitis optica spectrum disorders: An update. Ann Indian Acad Neurol. 2015;18:S11–5. - PMC - PubMed
    1. Kitley JL, Leite MI, George JS, Palace JA. The differential diagnosis of longitudinally extensive transverse myelitis. Mult Scler. 2012;18:271–85. - PubMed
    1. Luft BJ, Remington JS. AIDS commentary. Toxoplasmic encephalitis. J Infect Dis. 1988;157:1–6. - PubMed
    1. García-García C, Castillo-Álvarez F, Azcona-Gutiérrez JM, Herraiz MJ, Ibarra V, Oteo JA, et al. Spinal cord toxoplasmosis in human immunodeficiency virus infection/acquired immunodeficiency syndrome. Infect Dis (Lond) 2015;47:277–82. - PubMed
    1. Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: Central nervous system infections associated with human immunodeficiency virus infection: Radiologic-pathologic correlation. Radiographics. 2008;28:2033–58. - PubMed

Publication types