Lumbar cistern Candida intradural abscess following epidural anesthesia
Gabrielle Santangelo1, Jonathan Stone1, Mahlon Johnson2
1Department of Neurosurgery, University of Rochester, Strong Memorial Hospital, Rochester, New York, United States.
Background:
This report describes a case of an immunocompetent patient with an intradural abscess from Candida dubliniensis. The majority of fungal spine infections, although rare in general, are due to Aspergillus or C. albicans through systemic fungemia. To date, there have only been two reports of spondylodiscitis from C. dubliniensis.
Case Description:
A 37-year-old immunocompetent female patient presented to the neurosurgical service for worsening headaches with nausea, vomiting, vision changes, and weight loss. MRI studies showed diffuse leptomeningeal enhancement of the distal spinal cord, conus medullaris, and nerve roots of the cauda equina extending beyond the neural foramina bilaterally. She had persistent symptoms and no clear diagnosis on lumbar puncture or systemic testing therefore L5-S1 laminectomy for an intradural tissue biopsy was performed. During surgery, cultures were taken and grew colonies of C. dubliniensis.
Conclusion:
This organism has been reported rarely in the literature as being an infectious agent, thus diagnosing remains a challenge but should be considered in patients with a suggestive history.
Insights
This case report details an intradural abscess caused by Candida dubliniensis in an immunocompetent patient. This rare fungal spine infection highlights diagnostic challenges and the need for consideration in specific clinical scenarios.
Area of Science:
- Medical Mycology
- Neurosurgery
- Infectious Diseases
Background:
- Fungal spine infections are rare, with Aspergillus and Candida albicans being the most common causative agents.
- Intradural abscesses are an uncommon manifestation of fungal spinal infections.
- Candida dubliniensis is a rare cause of spondylodiscitis, with only two previous reports in the literature.
Observation:
- A 37-year-old immunocompetent female presented with neurological symptoms including headaches, nausea, vomiting, vision changes, and weight loss.
- MRI revealed diffuse leptomeningeal enhancement of the spinal cord and cauda equina.
- Despite extensive workup including lumbar puncture, diagnosis remained elusive until surgical biopsy.
Findings:
- Surgical exploration and tissue biopsy identified Candida dubliniensis as the causative organism of the intradural abscess.
- Intradural abscess formation by Candida dubliniensis is exceptionally rare.
- The patient was immunocompetent, challenging typical assumptions about risk factors for invasive fungal infections.
Implications:
- This case underscores the importance of considering rare fungal pathogens, such as Candida dubliniensis, in the differential diagnosis of spinal infections.
- Diagnostic challenges associated with Candida dubliniensis necessitate a high index of suspicion in patients with suggestive symptoms.
- Further research into the pathogenesis and diagnostic strategies for Candida dubliniensis spinal infections is warranted.
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