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Spinal intrathecal actinomycosis: a case report
S Ushikoshi1, I Koyanagi, K Hida
1Department of Neurosurgery, University of Hokkaido, School of Medicine, Sapporo, Japan.
Background:
Actinomycosis of the central nervous system is a rare disease that most frequently forms cerebral abscesses. In the present report, we describe an extremely rare case of spinal intrathecal actinomycosis.
Case Presentation:
A 33-year-old man presented with high fever followed by back pain and paraparesis. Magnetic resonance imaging (MRI) with gadolinium-diethylene-triamine penta-acetic acid (Gd-DTPA) enhancement (Gd-MRI) displayed an irregularly enhanced mass lesion at the thoraco-lumbar junction that mimicked an intramedullary tumor with exophytic growth. Surgical exploration 7 months after the onset of the high fever revealed intrathecal granulation tissue with small abscess formation. Another surgical exploration was carried out 2 months after the first operation because the patient developed progressive paraparesis and showed an intrathecal ring-like enhancement that was detected with Gd-MRI. Actinomyces organisms were finally identified histologically in the surgical specimen.
Conclusions:
The clinical course and serial changes of Gd-MRI findings are important considerations when this rare and infectious spinal lesion is suspected.
Insights
This case report details a rare instance of spinal actinomycosis, an infection typically affecting the brain. Early recognition of clinical signs and serial MRI findings is crucial for diagnosing this unusual spinal condition.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Actinomycosis of the central nervous system is rare, usually presenting as cerebral abscesses.
- This report focuses on an exceptionally rare case of spinal intrathecal actinomycosis.
Observation:
- A 33-year-old man presented with fever, back pain, and paraparesis.
- MRI revealed an enhancing mass mimicking a tumor at the thoraco-lumbar junction.
- Progressive symptoms led to repeat surgery, revealing granulation tissue and abscesses.
Findings:
- Actinomyces organisms were identified histologically in surgical specimens.
- Serial MRI showed ring-like enhancement, aiding diagnosis.
Implications:
- The clinical course and serial MRI changes are vital for suspecting spinal actinomycosis.
- This case highlights the importance of considering rare infections in spinal pathologies.