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Compartmentalized Histoplasma capsulatum Infection of the Central Nervous System.

Eid AJ, Leever JD, Husmann K - Case Rep Infect Dis (2015)

Bottom Line: Background.Discussion.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

ABSTRACT
Background. Histoplasmosis is a common fungal infection in the southeastern, mid-Atlantic, and central states; however, its presentation can be atypical. Case Presentation. We report a case of Histoplasma capsulatum infection presenting as slowly progressive weakness in the lower extremities, followed by the development of numbness below the midthoracic area, urinary incontinence, and slurred speech. Brain MRI showed leptomeningeal enhancement, predominantly linear, involving the basal cisterns, the brainstem, and spinal cord. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Discussion. CNS histoplasmosis is usually seen in patients with disseminated histoplasmosis. Isolated CNS histoplasmosis is rarely seen, especially in immunocompetent patients. Conclusions. Histoplasmosis should be considered in the differential diagnosis of patients experiencing slowly progressive neurological deficit.

No MeSH data available.


Related in: MedlinePlus

Sagittal T1 postcontrast image of the cervical spine: linear leptomeningeal enhancement along the cervical and visualized upper thoracic spinal cord.
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fig2: Sagittal T1 postcontrast image of the cervical spine: linear leptomeningeal enhancement along the cervical and visualized upper thoracic spinal cord.

Mentions: After transfer to our facility, a second LP was performed, three days after the initial one. CSF analysis revealed 248 wbc/mm3 (77% lymphocytes, 6% neutrophils, and 17% monocytes), protein 340 mg/dL, and glucose 51 mg/dL. Routine bacterial culture was again negative. C-reactive protein and procalcitonin levels were normal. Repeat brain and spine MRI at our facility showed mild improvement of the meningeal enhancement (Figures 1, 2, and 3). Repeat CSF analysis two days later revealed 25 rbc/mm3, 150 wbc/mm3 (61% neutrophils, 23% lymphocytes, and 16% monocytes), glucose 14 mg/dL, and protein 587 mg/dL. The shift from lymphocytes to neutrophils was felt to be due to steroid therapy. The CD4 lymphocyte count was 372 (58.5%), despite treatment with steroids. The work-up at this point focused on ruling out a fungal infection since TB seemed unlikely.


Compartmentalized Histoplasma capsulatum Infection of the Central Nervous System.

Eid AJ, Leever JD, Husmann K - Case Rep Infect Dis (2015)

Sagittal T1 postcontrast image of the cervical spine: linear leptomeningeal enhancement along the cervical and visualized upper thoracic spinal cord.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496644&req=5

fig2: Sagittal T1 postcontrast image of the cervical spine: linear leptomeningeal enhancement along the cervical and visualized upper thoracic spinal cord.
Mentions: After transfer to our facility, a second LP was performed, three days after the initial one. CSF analysis revealed 248 wbc/mm3 (77% lymphocytes, 6% neutrophils, and 17% monocytes), protein 340 mg/dL, and glucose 51 mg/dL. Routine bacterial culture was again negative. C-reactive protein and procalcitonin levels were normal. Repeat brain and spine MRI at our facility showed mild improvement of the meningeal enhancement (Figures 1, 2, and 3). Repeat CSF analysis two days later revealed 25 rbc/mm3, 150 wbc/mm3 (61% neutrophils, 23% lymphocytes, and 16% monocytes), glucose 14 mg/dL, and protein 587 mg/dL. The shift from lymphocytes to neutrophils was felt to be due to steroid therapy. The CD4 lymphocyte count was 372 (58.5%), despite treatment with steroids. The work-up at this point focused on ruling out a fungal infection since TB seemed unlikely.

Bottom Line: Background.Discussion.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

ABSTRACT
Background. Histoplasmosis is a common fungal infection in the southeastern, mid-Atlantic, and central states; however, its presentation can be atypical. Case Presentation. We report a case of Histoplasma capsulatum infection presenting as slowly progressive weakness in the lower extremities, followed by the development of numbness below the midthoracic area, urinary incontinence, and slurred speech. Brain MRI showed leptomeningeal enhancement, predominantly linear, involving the basal cisterns, the brainstem, and spinal cord. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Discussion. CNS histoplasmosis is usually seen in patients with disseminated histoplasmosis. Isolated CNS histoplasmosis is rarely seen, especially in immunocompetent patients. Conclusions. Histoplasmosis should be considered in the differential diagnosis of patients experiencing slowly progressive neurological deficit.

No MeSH data available.


Related in: MedlinePlus