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[Subacute meningoradiculomyeloencephalitis due to cryptococcosis infection]
1Service de neurologie, hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France. drouetalain@yahoo.fr
La Revue De Medecine Interne
|May 17, 2005
Summary
Intramedullary spinal cord cryptococcosis is rare but should be suspected in immunocompromised patients with myelopathy. Prompt antifungal treatment is crucial for recovery, with surgery reserved for decompression.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Central nervous system (CNS) cryptococcosis typically presents as meningoencephalitis.
- Intramedullary spinal cord involvement is an uncommon manifestation of cryptococcal infection.
Observation:
- A 70-year-old male with Hodgkin's disease and pulmonary fibrosis developed ataxia, pyramidal syndrome, and bradypsychy.
- Spinal MRI revealed an enhancing intramedullary lesion at T4.
- Cerebrospinal fluid (CSF) analysis showed lymphomonocytic pleocytosis, elevated protein, low glucose, and positive cryptococcal antigen.
Findings:
- The patient was diagnosed with intramedullary cryptococcosis.
- Treatment with amphotericin B, flucytosine, and subsequent fluconazole led to gradual symptom improvement.
- Cryptococcal antigen testing in CSF is vital for diagnosing myelopathy, especially in immunocompromised individuals.
Implications:
- Early diagnosis and treatment of spinal cord cryptococcosis are essential for favorable outcomes.
- Antifungal therapy is the primary treatment; surgery is indicated only for decompression.
- Prolonged antifungal treatment is necessary for immunocompromised patients to prevent relapse.