Disseminated coccidioidomycosis-related cervical intramedullary lesion causing quadriplegia in an immunocompetent host

• Published in: BMJ case reports Vol. 2017; p. bcr-2017-221474
• Main Authors: Noto, James Michael, Nahra, Raquel, Kavi, Tapan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.12.2017; BMJ Publishing Group
• Subjects: Adult; Case reports; Cervical Cord - diagnostic imaging; Cervical Cord - microbiology; Coccidioides; Coccidioidomycosis - complications; Coccidioidomycosis - microbiology; Humans; Hydrocephalus; Images In; Immunocompetence; Male; Medical diagnosis; Meningitis; Neuroimaging; Paralysis; Quadriplegia - diagnostic imaging; Quadriplegia - microbiology; Spinal cord; Spinal Cord Neoplasms - complications; Spinal Cord Neoplasms - diagnostic imaging; Spinal Cord Neoplasms - microbiology; United States > US; Mexico; California; infection (neurology); coma and raised intracranial pressure; spinal cord; hydrocephalus; neuroimaging
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-221474

Description A 41-year-old man with a history of crystal methamphetamine and alcohol abuse had progressive fever, nausea, headache, gait difficulties and seizures over 4 weeks while living in California and Mexico. Cerebrospinal fluid culture ( figure 1F ) and coccidioides IgG antibody by ELISA of 3.1ng/mL later confirmed the diagnosis of coccidioidomycosis Figure 1; (A) MRI of brain with gadolinium, axial view showing enhancement consistent with extensive basilar pachymeningitis, and leptomeningitis. Disseminated coccidioidomycosis is seen in only 1%-5% of infected patients. 1 2 Recognising the complication of spinal cord intramedullary involvement is important as delayed diagnosis and treatment can lead to poor outcomes. 3 Learning points Even in an immunocompetent host, intramedullary spinal cord involvement can be a manifestation of disseminated coccidioidomycosis and accompany the more recognisable presentation of coccidioidal meningitis.