Myeloradiculitis caused by Cryptococcus neoformans infection in a patient with ulcerative colitis: a neuropathological study
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Hiroyuki Murai1, Hideaki Tokunaga, Ikuko Kubo
1Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan. hmurai@neuro.med.kyushu-u.ac.jp
Abstract:
Meningitis is the most common feature of cryptococcal infection of the nervous system. We herein describe the case of a 48-year-old man with fulminant cryptococcal myeloradiculitis, whose initial symptoms were impotence, dysuria and weakness of the lower extremities. He had been administered prednisolone and azathioprine for 7years for ulcerative colitis before onset of myeloradiculitis. He finally developed meningoencephalitis and died 2 months after onset despite treatment with amphotericin B and flucytosine. Post-mortem examination revealed numerous infiltrations of cryptococci in the spinal roots as well as in the meninges and subarachnoid space. Inflammatory cells and cryptococci had infiltrated the vessel walls in the spinal cord, and this was accompanied by necrotizing myelopathy. Myeloradiculitis is rare in cryptococcal infection, and this is the first case report to demonstrate direct cryptococcal infection in the spinal roots. Cryptococcal infection should be considered while managing myeloradiculopathy of unknown etiology, especially in immunocompromised patients.
Insights
Cryptococcal myeloradiculitis, a rare spinal cord infection, occurred in an immunocompromised patient. This case highlights direct spinal root involvement by Cryptococcus, leading to fatal meningoencephalitis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Cryptococcal infections commonly affect the central nervous system, primarily causing meningitis.
- Immunosuppression, particularly from long-term corticosteroid and azathioprine use for ulcerative colitis, increases susceptibility to opportunistic infections.
Observation:
- A 48-year-old man presented with impotence, dysuria, and lower extremity weakness, indicative of myeloradiculopathy.
- Despite treatment with amphotericin B and flucytosine, the patient developed meningoencephalitis and died within two months.
Findings:
- Post-mortem examination confirmed extensive Cryptococcus neoformans infiltration in spinal roots, meninges, and subarachnoid space.
- Necrotizing myelopathy was observed, with inflammatory cells and fungi invading spinal cord vessels, confirming direct cryptococcal myeloradiculitis.
- This case represents the first documented instance of direct cryptococcal infection targeting spinal roots.
Implications:
- Cryptococcal myeloradiculitis is a rare but severe complication of cryptococcal infection, particularly in immunocompromised individuals.
- Clinicians should consider cryptococcal infection in the differential diagnosis of unexplained myeloradiculopathy, especially in patients with compromised immune systems.
- This case underscores the importance of early recognition and aggressive management of opportunistic infections in immunosuppressed patients.
