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Published on: February 14, 2011
Acute Myelopathy as Initial Presentation of Disseminated Histoplasmosis: A Case Report
Lisle Blackbourn1,2, Elisa Yoo3, Michael D Lunt4
1Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.
Abstract:
Histoplasmosis is a fungal infection caused by the fungus Histoplasma capsulatum that can rarely present with central nervous system (CNS) manifestations that include meningitis, encephalitis, focal brain or spinal cord lesions, and stroke syndromes. Because of this variation from patient to patient, CNS histoplasmosis is a difficult clinical diagnosis to make, which can be further hindered by no highly sensitive diagnostic testing available. Here, we present a unique case of a 46-year-old male immunocompromised due to type 1 diabetes mellitus with disseminated histoplasmosis as an acute presentation of myelopathy. Patient had left leg weakness for a few days prior to presentation and a neurological exam remarkable for signs of acute thoracic myelopathy, specifically concerning for Brown-Séquard syndrome. MRI imaging demonstrated an enhancing thoracic spinal cord lesion along with multiple cerebral enhancing lesions, bilateral adrenal masses, and innumerable pulmonary nodules. Biopsy results demonstrated yeast forms consistent with Histoplasma species.
Insights
This case study highlights a rare presentation of disseminated histoplasmosis in an immunocompromised patient, manifesting as acute thoracic myelopathy. Diagnosis was confirmed via biopsy, emphasizing the challenges in identifying this fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Histoplasmosis, caused by *Histoplasma capsulatum*, is a fungal infection.
- Central nervous system (CNS) involvement is rare but can present diversely, including meningitis, encephalitis, and lesions.
- CNS histoplasmosis poses diagnostic challenges due to varied presentations and limited sensitive tests.
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