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Chronic mycotic meningitis with spinal involvement (arachnoiditis): a report of five cases
Abstract:
Five patients developed mycotic spinal arachnoiditis-meningitis causing signs and symptoms of spinal cord neoplasm. Four had cryptococcal infection, the fifth had aspergillosis. In three patients, diagnosis was made at surgery; all three developed acute fungal meningitis postoperatively and two died. The diagnosis was made nonsurgically in two patients and was followed by medical cure. These five and twelve other reported patients with mycotic spinal arachnoiditis shared features that suggested the diagnosis. In contrast to most patients with spinal tumors, those reported here tended to be young (mean age, 32 years), to lack evidence for a primary tumor, and to have a fluctuating history of spinal symptoms for several months. Frequent associated findings were recent pregnancy; the abuse of alcohol, narcotics, or both; and the presence of headache and fever. Plain roentgenograms of the spine were normal. No single finding was diagnostic, but the combination of several would be rare with spinal tumor.
Insights
Mycotic spinal arachnoiditis-meningitis can mimic spinal cord tumors, particularly in younger patients. Early non-surgical diagnosis and treatment are crucial for better outcomes in fungal meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Mycotic spinal arachnoiditis-meningitis is a rare condition that can present with symptoms mimicking a spinal cord neoplasm.
- Distinguishing fungal meningitis from neoplastic spinal cord compression is clinically challenging.
Observation:
- Five patients presented with signs and symptoms suggestive of spinal cord tumors due to fungal infections (four cryptococcal, one aspergillosis).
- Diagnosis at surgery led to poor outcomes, with two of three patients dying from postoperative fungal meningitis.
- Non-surgical diagnosis in two patients resulted in successful medical cure.
Findings:
- Patients with mycotic spinal arachnoiditis often differ from those with spinal tumors: they tend to be younger (mean age 32), lack primary tumor evidence, and have fluctuating symptoms over months.
- Associated factors include recent pregnancy, substance abuse (alcohol, narcotics), headache, and fever.
- Spine roentgenograms are typically normal, and no single finding is diagnostic, but a combination of features can suggest the diagnosis over a tumor.
Implications:
- Recognizing the distinct clinical features of mycotic spinal arachnoiditis is vital for accurate diagnosis and timely intervention.
- Non-surgical diagnostic approaches and prompt medical treatment can significantly improve patient prognosis.
- This condition highlights the importance of considering infectious etiologies in the differential diagnosis of spinal cord compression syndromes.