Intramedullary histoplasmosis lesion in children: A case report

Abstract

Background: Histoplasmosis is a fungal disease endemic in some regions of the United States of America, Canada, and Latin America. The geographic characteristics, humidity, soil, and climate are responsible for such distribution. In Brazil, there are case reports of histoplasmosis throughout its territory, being considered an endemic region. It is considered an opportunistic disease, affecting mostly immunocompromised patients. To the present date, scientific publications dealing with pediatric cases of histoplasmosis are restricted to case series. Spinal cord injuries caused by histoplasmosis are rare, even in the adult population, being described in few studies. Case Description: The present report deals with a 4-year-old patient, from the southeast region of Brazil, who started a condition of fever, weight loss, cervicobrachialgia, and symmetrical tetraparesis, with evolution over 2 months. In the diagnostic investigation, she was found to have primary immunodeficiency and neuroimaging examinations showed a cervical spinal cord lesion at the level of C4-C6. The anatomopathological diagnosis of histoplasmosis was possible after surgery for decompression and biopsy of the lesion. Conclusion: According to our research, there are no reports in the literature that address the situation of spinal cord compression syndrome due to histoplasmosis in the pediatric population.

Intramedullary histoplasmosis of the thoracic cord as an isolated lesion: A rare case report and literature review

“…[ 5 ] Differential diagnoses for these intramedullary lesions include: infections (i.e., syphilis, fungal infections, tuberculosis, and other mycobacteria), demyelinating diseases (acute demyelinating encephalomyelitis), or neoplastic causes. [ 7 ]…”

“…The diagnosis of CNS histoplasmosis is challenging and typically delayed. [ 7 ] The most sensitive method to document histoplasmosis is the antibody and antigen tests of the CSF. [ 11 ] Although a CSF positive culture is the gold standard for confirming the diagnosis of CNS histoplasmosis, it has a low sensitivity, and culture growth may take several weeks potentially delaying diagnostic confirmation.…”

“…[ 1 ] Alternatively, biopsy for accessible lesions may be the most rapid and definitive diagnostic technique. [ 7 ]…”

“…Intramedullary Negative Progressive paraparesis T12-L1 laminectomy and itraconazole Recker et al [6] 44 Male T3. Intramedullary Positive Clumsiness and numbness of his left-lower extremity Amphotericin B and methylprednisolone; followed by itraconazole and prednisone Renan et al [7] 4 Female C4-C6. Intramedullary…”

“…Approximately 1/3 of cases occur in immunocompetent versus 2/3 in immunosuppressed individuals. [ 4 , 6 , 7 ] Here, a 45-year-old female presented with a T8–T9 intramedullary focus of histoplasmosis resulting in spinal cord dilatation/compromise responsible for a severe paraparetic deficit that largely resolved following lesion resection.…”