Intramedullary histoplasmosis spinal cord abscess in a nonendemic region

Case report and review of the literature

Jonathan S. Hott, Eric Horn, Volker K H Sonntag, Stephen W. Coons, Andrew Shetter

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

An immunocompetent patient from a nonendemic region developed a rare intramedullary thoracic histoplasmoma. A native Arizonan, with no history of travel to endemic regions, received 3 months of itraconazole for confirmed gastrointestinal histoplasmosis at an outside institution. Two years later she experienced the rapid onset of paraplegia and lost bowel and bladder function. Magnetic resonance imaging demonstrated a ring-enhancing intramedullary lesion at T2 and signal abnormality from C2 to T5. Emergent T2-T3 laminectomy was performed with ultrasonographically guided intradural exploration and midline myelotomy. The intramedullary abscess was drained. She was nonambulatory, but motor function was partially restored. An Ommaya reservoir was later placed to deliver amphotericin and a new antifungal agent, voriconazole. Magnetic resonance imaging confirmed that the infection had resolved. Intramedullary spinal histoplasmoma is a rare manifestation of disseminated histoplasmosis, particularly in nonendemic regions. Surgery for focal mass lesions and aggressive antifungal chemotherapy are the optimal treatment. Newer central nervous system-penetrating antibiotics show promise in refractory cases.

Original languageEnglish (US)
Pages (from-to)212-215
Number of pages4
JournalJournal of Spinal Disorders and Techniques
Volume16
Issue number2
StatePublished - Apr 2003
Externally publishedYes

Fingerprint

Histoplasmosis
Abscess
Spinal Cord
Magnetic Resonance Imaging
Itraconazole
Laminectomy
Antifungal Agents
Paraplegia
Amphotericin B
Urinary Bladder
Thorax
Central Nervous System
Anti-Bacterial Agents
Drug Therapy
Infection
Therapeutics
Voriconazole

Keywords

  • Abscess
  • Histoplasmosis
  • Intramedullary
  • Spinal cord
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Intramedullary histoplasmosis spinal cord abscess in a nonendemic region : Case report and review of the literature. / Hott, Jonathan S.; Horn, Eric; Sonntag, Volker K H; Coons, Stephen W.; Shetter, Andrew.

In: Journal of Spinal Disorders and Techniques, Vol. 16, No. 2, 04.2003, p. 212-215.

Research output: Contribution to journalArticle

Hott, Jonathan S. ; Horn, Eric ; Sonntag, Volker K H ; Coons, Stephen W. ; Shetter, Andrew. / Intramedullary histoplasmosis spinal cord abscess in a nonendemic region : Case report and review of the literature. In: Journal of Spinal Disorders and Techniques. 2003 ; Vol. 16, No. 2. pp. 212-215.
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