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Raffa PEAZ, Vencio RCC, Ponce ACC, Malamud BP, Vencio IC, Pacheco CC, Costa FD, Franceschini PR, Medeiros RTR, Aguiar PHP. Spinal intramedullary abscess due to Candida albicans in an immunocompetent patient: A rare case report. Surg Neurol Int 2021; 12:275. [PMID: 34221606 PMCID: PMC8247672 DOI: 10.25259/sni_435_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background: A spinal intramedullary abscess is a rare clinical entity in which patients classically present with a subacute myelopathy and progressive paraplegia, sensory deficits, and/or bowel and bladder dysfunction. We report the second case of spinal intramedullary abscess caused by Candida albicans to ever be published and the first case of its kind to be surgically managed. Case Description: A 44-year-old female presented with severe lumbar pain associated with paraparesis, incontinence, and paraplegia. She reported multiple hospital admissions and had a history of seizures, having already undergone treatment for neurotuberculosis and fungal infection of the central nervous system unsuccessfully. Nevertheless, no laboratory evidence of immunosuppression was identified on further investigation. Magnetic resonance imaging showed a D10-D11, well-circumscribed, intramedullary mass within the conus, which was hypointense on T1-weighted imaging and hyperintense on T2/STIR weighted. The patient underwent surgery for removal and biopsy of the lesion, which provided the diagnosis of an intramedullary abscess caused by C. albicans, a very rare condition with only one case reported in literature so far. Conclusion: C. albicans intramedullary abscess is a very rare clinical entity, especially in immunocompetent patients. We highlight C. albicans as an important etiology that must be considered in differential diagnosis. Critical evaluation of every case, early diagnosis, timely referral and surgical management of the abscess is essential to improve neurological outcome.
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Affiliation(s)
| | | | | | | | - Isabela Caiado Vencio
- Department of Medicine, School of Medicine of Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brazil
| | | | | | - Paulo Roberto Franceschini
- Department of Neurology and Neurosurgery, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | | | - Paulo Henrique Pires Aguiar
- Department of Medicine, Division of Neurology, Catholic Pontifical University of São Paulo, Sorocaba, São Paulo, Brazil
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Warsi NM, Wilson A, Malhotra AK, Ku JC, Najjar AA, Bui E, Baker M, Bartlett E, Hodaie M. Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2035. [PMID: 36131588 PMCID: PMC9628101 DOI: 10.3171/case2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess. OBSERVATIONS The patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection. LESSONS The authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.
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Affiliation(s)
- Nebras M. Warsi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ann Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Armaan K. Malhotra
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jerry C. Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed A. Najjar
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Esther Bui
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Michael Baker
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Eric Bartlett
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Vo DT, Cravens GF, Germann RE. Streptococcus pneumoniae meningitis complicated by an intramedullary abscess: a case report and review of the literature. J Med Case Rep 2016; 10:290. [PMID: 27756423 PMCID: PMC5069864 DOI: 10.1186/s13256-016-1080-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intramedullary abscess is a rare neurosurgical condition that usually arises in the setting of penetrating trauma to the spinal cord, infected congenital dural sinuses, or tuberculosis. CASE PRESENTATION We describe a case of a 35-year-old African American male who presented with sepsis and a clinical picture of meningitis. The patient continued to have declining neurological status with decreasing sensation and worsening motor strength in all four extremities. He was found to have an intramedullary abscess in the cervical spinal cord that was treated with a decompressive posterior cervical laminectomy and drainage. The patient began to have a partial recovery of neurological function postoperatively. We also review the literature on intramedullary abscess that suggests the clinical presentation of our patient was a rare complication of acute meningitis. CONCLUSIONS Intramedullary abscess formation is a rare entity, and a high index of suspicion for intramedullary abscess is the key for making the diagnosis and expediting treatment for these patients.
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Affiliation(s)
- Dat T Vo
- Department of Pediatrics, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA. .,Department of Neurosurgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA. .,The Center for Neurological Disorders, 1010 Houston Street, Fort Worth, TX, 76102, USA. .,Department of Radiation Oncology, The University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, TX, 75390, USA.
| | - George F Cravens
- Department of Neurosurgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA.,The Center for Neurological Disorders, 1010 Houston Street, Fort Worth, TX, 76102, USA
| | - Robert E Germann
- Department of Neurosurgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA.,The Center for Neurological Disorders, 1010 Houston Street, Fort Worth, TX, 76102, USA
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