Disseminated coccidioidomycosis presenting with intramedullary spinal cord abscesses: Management challenges

Bajema, Kristina L.; Dalesandro, Mark F.; Fredricks, David N.; Ramchandani, Meena

doi:10.1016/j.mmcr.2016.12.001

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…On occasion, the clinical presentation can be more insidious, mimicking a spinal tumor or other conditions capable of inducing chronic myelopathy [38]. Multifocality of abscesses can further complicate an already complex clinical picture [39]. Finally, recurrent meningitis may also result from the rupture of such abscesses into the subarachnoid space [40,41].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

et al. 2022

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Background Intramedullary abscesses are rare infections of the spinal cord. Intramedullary abscesses often have a complex presentation, making a high index of suspicion essential for prompt diagnosis and management. Case presentation We present two cases of intramedullary abscesses referred to and ultimately managed at our institution. Delayed diagnosis occurred in both instances due to the rarity of intramedullary abscesses and their propensity to mimic other pathologies. For both patients, prompt surgical management and the rapid institution of broad-spectrum antibiotics were critical in preventing further neurological decline. Conclusions Although rare, it is critical to consider intramedullary abscesses on the differential for any MRI lesions that are hyperintense on T2 and peripherally enhancing on T1 post-contrast sequences, as even short delays in treatment can lead to severe neurological damage.

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Section: Discussionmentioning

confidence: 99%

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

et al. 2022

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“…Such involvement has been reported rarely in the form of intramedullary abscess and enhancing intramedullary lesions. 18,19 Men are much more commonly affected, potentially secondary to environmental/work exposure. The military has studied this extensively due to marine base locations in the San Joaquin Valley and frequent engagement in outdoor exercises.…”

Section: Discussionmentioning

confidence: 99%

Spinal Coccidioidomycosis: MR Imaging Findings in 41 Patients

Crete

Gallmann

Karis

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Coccidioides immitis is a dimorphic fungus endemic to the Southwest United States and Mexico, and at our institution, it is a relatively common pathogen presenting with a broad spectrum of associated spine diseases. We describe the various spinal manifestations resulting from coccidioidal infection and provide MR imaging examples from 41 pathologically proved cases. MATERIALS AND METHODS: Retrospective electronic medical record and PACS searches were performed. Patients found to have both MR imaging findings positive for infection and confirmative biopsy and/or CSF studies were included. Abnormal MR imaging findings were identified, categorized, and quantified. Patient demographics and associated intracranial involvement if present were also recorded. RESULTS: Forty-one patients were included. Positive findings were categorized as leptomeningeal enhancement (26 patients, 63%), arachnoiditis (22 patients, 54%), osteomyelitis-discitis (14 patients, 34%), cord edema (11 patients, 27%), and true syrinx (3 patients, 7%). Thirty patients had documented brain involvement (73%), most commonly in the form of basilar meningitis. Four patients were positive for HIV (10%). Fifteen patients had pulmonary manifestations at presentation (37%). CONCLUSIONS: C immitis results in various spinal manifestations, most commonly leptomeningeal enhancement and arachnoiditis/ adhesive disease followed by osteomyelitis, which may resemble tuberculous or pyogenic infection on MR imaging. ABBREVIATION: T1ϩC ϭ T1-weighted images with contrast Coccidioides immitis is a dimorphic fungus well-known to be endemic to the Southwest United States and Mexico. 1,2 At our institution, we experience C immitis as a relatively common pathogen, presenting with variable pulmonary, intracranial, and spinal diseases regardless of immune status. The spectrum of spine disease reported in the literature is extensive, with involvement of the leptomeninges, epidural/paraspinal space, vertebral bodies both with and without disc involvement, and, rarely, the spinal cord. Although previous case reports and articles have discussed the imaging appearance of spinal coccidioidomycosis, to our knowledge, there has not been a comprehensive review of both intrathecal and vertebral/paraspinal involvement of this magnitude. 3-9 We describe the spinal MR imaging findings from 41 patients with pathologically proved Coccidioides infection.

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“…The patient was treated with prolonged systemic liposomal amphotericin B, voriconazole, and an extended course of corticosteroids. Even though the patient was stabilized, he suffered severe neurological deficits along with the sequelae from the toxicity of steroids and antifungal treatment [ 15 ]. Rapidly progressing quadriparesis in the setting of disseminated coccidioidomycosis with cervical intramedullary involvement has been described in a case report of a 55-year-old man who required emergent cervical laminectomies with dural biopsy for decompression of the spinal cord and confirmation of the diagnosis and succumbed to the progressive course of the disease [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Myelitis due to Coccidioidomycosis in an Immunocompetent Patient

Vaysman

Villaflores

Estrella

et al. 2018

Case Reports in Infectious Diseases

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Myelitis of the spinal cord is an uncommon presentation of disseminated coccidioidomycosis. Most infected patients present subclinically, but patients, especially those who are immunocompromised, may progress to disseminated disease. We present a 50-year-old immunocompetent patient with no significant past medical history exhibiting symptoms of altered mental status, dizziness, headache, nausea, and quadriplegia. Upon investigation with lumbar puncture, cerebrospinal fluid (CSF) culture, and coccidioidal antibody studies, the patient was found to have acute coccidioidomycosis. Magnetic resonance imaging (MRI) of the brain demonstrated meningeal enhancements suggestive of meningitis, and further MRI study of the cervical spine revealed myelitis. Treatment with IV fluconazole for 2 weeks and IV voriconazole therapy over 3 weeks yielded limited improvement. The presentation of myelitis due to coccidioidomycosis infection is very rare and has infrequently reported in the literature. Awareness of this potentially fatal complication in immunocompetent patients can aid in faster recognition and treatment.

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Disseminated coccidioidomycosis presenting with intramedullary spinal cord abscesses: Management challenges

Cited by 17 publications

References 15 publications

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

Spinal Coccidioidomycosis: MR Imaging Findings in 41 Patients

Myelitis due to Coccidioidomycosis in an Immunocompetent Patient

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