Cauda equina syndrome secondary to disseminated zygomycosis

We describe a case of cauda equina syndrome secondary to disseminated zygomycosis. A 52-year-old man had myelodysplastic syndrome, progressive weakness of the lower extremities, and incontinence. Neuroradiological findings were consistent with lumbar stenosis and probable disk herniation. A lung lesion was also discovered on the chest roentgenogram. The patient's condition rapidly deteriorated after surgical decompression. Attempts at determining other etiologies were unsuccessful. At autopsy, disseminated zygomycosis was found affecting the lung and the vasculature of the cauda equina and lumbosacral nerve roots, with resultant focal demyelination of these structures. Ribbon-like hyphal elements were also present in the caudal roots. This opportunistic pathogen is discussed along with the diagnostic challenge presented by its unusual clinical presentation.