# Spinal Cord Toxoplasmosis: Mapping the Journey of a Rare Entity Through a Case Report and Review of the Literature

## TL;DR

This paper presents a rare case of spinal cord toxoplasmosis in an HIV-positive patient and reviews similar cases, highlighting the challenges in diagnosis and treatment.

## Contribution

The study provides a unique case report and a comprehensive review of spinal cord toxoplasmosis, emphasizing its clinical features and outcomes.

## Key findings

- Spinal cord toxoplasmosis often presents with paraparesis, sensory loss, and urinary retention.
- Most cases had concomitant cerebral lesions, and diagnosis frequently required histological confirmation.
- Neurological sequelae and high mortality rates were observed in the reviewed cases.

## Abstract

Toxoplasmosis remains the most frequent cause of cerebral lesions in patients with acquired immunodeficiency syndrome (AIDS), especially in those not receiving prophylaxis. Medullary involvement, although rare, can cause irreversible neurological damage. When associated with fever in the returning traveler, the etiological diagnosis of spinal cord lesions can be challenging due to the wide range of diagnostic possibilities. We report a unique case of spinal cord toxoplasmosis associated with Salmonella non-typhi bacteremia after a trip to Cameroon, revealing an advanced human immunodeficiency virus (HIV) infection in an otherwise healthy adult male. We also conducted a comprehensive review of reported spinal cord toxoplasmosis cases between the years 2000 and 2025 in both immunocompromised and immunocompetent patients. In our review, paraparesis, sensory loss, and urinary retention were the most frequent clinical presentations (52.17%; 56.52% and 47.84%, respectively), and the majority of the patients had concomitant cerebral lesions (78.26%). Diagnosis remains a challenge, with 48.0% of the reported cases diagnosed through histological detection of the parasite in central nervous system (CNS) tissue. Sulfadiazine–pyrimethamine with additional folinic acid and trimethoprim-sulfamethoxazole (TMP-SMX) remains the treatment of choice for treating cerebral toxoplasmosis in people living with HIV (PLHIV), with no particular recommendation regarding patients with spinal cord involvement. In the reviewed cases, neurological sequelae occurred in 52.2% of patients, and mortality was as high as 30.4%.