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Disseminated histoplasmosis presenting as bilateral lower extremity paresis

Andrew Simms1, Takaaki Kobayashi1, Levi Endelman2

  • 1Department of Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|April 10, 2020
PubMed

Insights

Histoplasmosis, a common fungal infection, can rarely affect the central nervous system (CNS). This case highlights spinal cord lesions as the sole CNS sign of disseminated histoplasmosis.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Histoplasmosis is a prevalent endemic mycosis in the US, caused by Histoplasma capsulatum.
  • Pulmonary involvement is the most common presentation, but disseminated disease can occur.
  • Central nervous system (CNS) involvement is a rare but serious complication.

Observation:

  • A unique case of CNS histoplasmosis is presented.
  • The patient exhibited multiple focal spinal cord lesions as the exclusive manifestation of CNS infection.
  • Symptoms included bilateral lower extremity paresis and sensory loss.

Findings:

  • The spinal cord lesions were the sole indicator of central nervous system (CNS) histoplasmosis.
  • This presentation underscores the diverse neurological manifestations of disseminated Histoplasma capsulatum infection.
  • Diagnosis required considering histoplasmosis in the differential for spinal cord pathology.

Implications:

  • Central nervous system (CNS) histoplasmosis should be considered in patients with unexplained neurological deficits, particularly in endemic areas.
  • This case expands the spectrum of CNS histoplasmosis presentations.
  • Early recognition and treatment are crucial for managing severe disseminated histoplasmosis.
Keywords:
Central nervous systemHistoplasmosisSpine lesions

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