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Fusarium species intramedullary spinal cord fungus ball: case report
Justice O Agyei1,2, Jingxin Qiu3, Andrew J Fabiano1,2
1Departments of1Neurosurgery and.
Abstract:
The Fusarium species are one of the most common opportunistic fungal infections occurring in immunocompromised patients and are associated with high morbidity and mortality. Common sites of infection include blood, skin, nasal passages, lungs, bone, and other visceral organs. There is a paucity of literature on Fusarium infections in the brain, and the true nature and extent of central nervous system involvement is not well described. To the authors' knowledge, there have been no reported cases of Fusarium infection of the spine. The authors report the case of a man with acute myeloblastic leukemia and resultant pancytopenia who presented with fungal sinusitis, upper- and lower-extremity weakness, and cardiopulmonary arrest. Imaging studies revealed a spinal cervical intramedullary ring-enhancing lesion. Because of the progressive nature of his symptoms, neurosurgical intervention involving a C2-3 laminectomy and drainage of the lesion was performed. Intraoperative cultures and histopathology results were positive for Fusarium species and, along with intraoperative findings, were consistent with a fungus ball. The patient was placed on a regimen of intravenous and intrathecal antifungal therapy. Unfortunately, his clinical condition declined postoperatively, and he ultimately died of disseminated infection.
Insights
Fusarium species cause opportunistic infections in immunocompromised patients. This case highlights a rare spinal cord infection by Fusarium, emphasizing the need for awareness in central nervous system fungal disease.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Fusarium species are opportunistic fungi causing significant morbidity and mortality in immunocompromised individuals.
- Common Fusarium infections involve blood, skin, and visceral organs, with limited data on central nervous system (CNS) involvement.
- Literature on Fusarium infections of the brain is scarce, and spinal cord involvement is virtually undescribed.
Observation:
- A patient with acute myeloblastic leukemia and pancytopenia presented with fungal sinusitis, neurological deficits, and cardiopulmonary arrest.
- Imaging revealed a cervical intramedullary ring-enhancing lesion in the spinal cord.
- Neurosurgical intervention identified a fungal ball consistent with Fusarium infection.
Findings:
- Histopathology and intraoperative cultures confirmed Fusarium species as the causative agent of the spinal lesion.
- The patient received intravenous and intrathecal antifungal therapy.
- Despite treatment, the patient's condition deteriorated due to disseminated infection.
Implications:
- This case represents the first reported instance of Fusarium infection of the spine.
- It underscores the potential for Fusarium to cause severe CNS disease, even in the spinal cord.
- Increased vigilance and diagnostic consideration for Fusarium are warranted in immunocompromised patients with neurological symptoms and suspected infections.
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