amphotericin-b and Spinal-Cord-Diseases

Infection of the nervous system by Cryptococcus neoformans most often causes meningitis and meningoencephalitis. While there have been several cases of cerebral cryptoccal granuloma published in the literature, the isolated occurrence of intramedullary cryptococcal granuloma is very rare. We present an immunocompetent patient with such a lesion of the conus medullaris. The patient's clinical symptoms mimicked an intramedullary spinal cord tumor. The diagnosis was made by histopathology, rather than by image or laboratory examinations. The case was successfully managed with surgical removal of the lesion and postoperative anti-fungal treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Diagnosis, Differential; Fluconazole; Granuloma; Humans; Immunocompetence; Laminectomy; Male; Spinal Cord Diseases; Spinal Cord Neoplasms

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Antifungal Agents; CD4 Lymphocyte Count; Histoplasma; Histoplasmosis; Humans; Magnetic Resonance Imaging; Male; Muscle Weakness; Nails; Neurologic Examination; Onychomycosis; Spinal Cord; Spinal Cord Diseases

To report a case of spinal intramedullary blastomycosis causing myelopathy.. An otherwise healthy 13-year-old patient was diagnosed with respiratory North American blastomycosis. She subsequently received a five-month course of itraconazole with presumed resolution of the infection. The patient presented again at 14 years of age with a lumbar myelopathy. Magnetic resonance imaging revealed an intramedullary lesion of 1 cm diameter at the level of T12-L1.. A T12-L1 laminectomy was performed with a gross total resection of the lesion. Pathological examination and microbiological culture of the specimen was consistent with blastomycosis. Postoperatively, the patient was placed on a five week course of amphotericin B. The patient showed substantial improvement in neurological function.. Blastomycosis can present as an isolated intramedullary lesion causing compromised function. It should be considered in the differential diagnosis of a patient with a myelopathy and previously recognized blastomycosis. The prognosis is good with surgical resection.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Female; Humans; Laminectomy; Lumbar Vertebrae; Osteitis; Spinal Cord Diseases; Treatment Outcome

We present the clinical, serological, and radiological features of a patient with a spinal intramedullary abscess caused by Candida albicans. Antimycotic treatment was successful, and no neurosurgical approach was necessary.

Topics: Abscess; Amphotericin B; Candidiasis; Flucytosine; Humans; Magnetic Resonance Imaging; Male; Medulla Oblongata; Middle Aged; Spinal Cord Diseases

Disseminated infection with Histoplasma capsulatum frequently involves the nervous system, but the CNS process is generally not clinically apparent. We report an unusual case of a renal transplant recipient with long-standing immunosuppression who presented with clinical evidence of mass lesions in both his cerebral cortex and his spinal cord. Findings of CSF examination were normal, but stereotaxic biopsies of his cortical lesions demonstrated yeast forms and cultures of biopsy specimens yielded H. capsulatum. Clinical defects referable to both the cortical and spinal lesions decreased in severity after the patient received antifungal therapy. Our case illustrates that disseminated histoplasmosis can present in myriad ways and that widespread disease in the CNS can be occult in immunocompromised patients.

Topics: Aged; Amphotericin B; Anorexia; Brain Diseases; Follow-Up Studies; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Magnetic Resonance Imaging; Male; Postoperative Complications; Spinal Cord Diseases; Weight Loss

An unusual case is reported of a patient with spastic paraparesis who was found to have severe spinal arachnoiditis due to Coccidioides immitis. Despite an obstructive hydrocephalus and a spinal subarachnoid block, the patient was treated effectively with surgery (shunting) and antifungal therapy (amphotericin and ketoconazole). He remains asymptomatic 3 years after diagnosis. Aggressive surgical and medical treatment of coccidioidal infection of the central nervous system can be beneficial, even in patients with the worst prognosis.

Topics: Adult; Amphotericin B; Arachnoiditis; Coccidioidomycosis; Humans; Imidazoles; Ketoconazole; Male; Piperazines; Spinal Cord Diseases

A case of an intrathecal cryptococcal granuloma in the cauda equina is reported. Successful and minimally toxic therapy with intrathecal amphotericin B and oral 5-fluorocytosine, preceded by surgery, is described.

Topics: Adolescent; Amphotericin B; Cauda Equina; Cryptococcosis; Flucytosine; Granuloma; Humans; Injections, Spinal; Male; Spinal Cord Diseases

Two patients with coccidioidal meningitis experienced transient neurologic deficits shortly after receiving intrathecal injections of amphotericin B. Continuation of treatment eventually led to a severe flaccid paraparesis with a thoracic sensory level in one patient, and a partial Brown-Séquard's syndrome in the other. Myelography was normal in both, with no evidence of arachnoiditis. Autopsy findings in the first patient showed a focal area of necrosis in the left half of the spinal cord consistent with the patient's clinical findings during life. The distribution of the lesion corresponded to the area supplied by a central sulcal artery. Amphotericin B may exert a direct toxic effect on the spinal cord or its vascular supply when given intrathecally.

Topics: Amphotericin B; Coccidiosis; Female; Humans; Injections, Spinal; Male; Meningitis; Middle Aged; Muscle Hypotonia; Myelography; Paralysis; Spinal Cord; Spinal Cord Diseases

Topics: Adult; Amphotericin B; Brain Diseases; Central Nervous System Diseases; Cryptococcosis; Cytosine; Fluorine; Granuloma; Humans; Male; Meningitis; Microscopy, Phase-Contrast; Middle Aged; Spinal Cord Diseases; Temporal Lobe

Topics: Adolescent; Amphotericin B; Arachnoiditis; Chromoblastomycosis; Cisterna Magna; Humans; Male; Spinal Cord Diseases; Subarachnoid Space

Topics: Acute Disease; Adult; Amphotericin B; Arachnoiditis; Cryptococcosis; Humans; Laminectomy; Male; Myelography; Spinal Cord Diseases; Subarachnoid Space