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Review
. 2020 Jan 10;20(1):13.
doi: 10.1186/s12883-020-1598-6.

Disseminated Cryptococcosis revealed by transverse myelitis in Immunocompetent patient: a case report and review of the literature

Fangfang Qu  1 , Zhenzhen Qu  2 , Yingqian Lv  3 , Bo Song  4 , Bailin Wu  5
Affiliations
Review

Disseminated Cryptococcosis revealed by transverse myelitis in Immunocompetent patient: a case report and review of the literature

Fangfang Qu et al. BMC Neurol. .

Abstract

Background: Transverse myelitis (TM) is due to inflammatory spinal cord injury with bilateral neurologic involvement, which is sensory, motor, or autonomic in nature. It may be associated with autoimmune disease, vaccination, intoxication and infections. The most common infection cause of TM is Coxsackie virus and Mycoplasma pneumoniae. The cryptococcosis is rare. We present the case of disseminated cryptococcosis revealed by transverse myelitis in an immunocompetent 55-year-old male patient. The literature review is also stated.

Case presentation: The 55-year-old man suffered from gradual numbness, weakness in both lower limbs and finally paralyzed in the bed. The thoracic spine Computed tomography (CT) was normal, but multiple nodules in the lung were accidentally discovered. Thoracic Magnetic Resonance Imaging (MRI) showed diffused thoracic spinal cord thickening and extensively intramedullary T2 hyper intensity areas. Gadolinium contrast enhanced T1WI showed an intramedullary circle-enhanced nodule at 9th thoracic level. Diagnosis was made by histological examination of the bilateral lung biopsy. The patient was treated successfully with systemic amphotericin B liposome and fluconazole and intrathecal dexamethasone and amphotericin B liposome.

Conclusions: This is a patient with disseminated cryptococcosis involving the lung, spinal cord and adrenal glands, which is rare in the absence of immunodeficiency.

Keywords: Cryptococcosis pneumonia; Disseminated Cryptococcosis; Immunocompetent; Metastatic tumor; Transverse myelitis; Tuberculosis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A1 showed longitudinal flaky hyper intense signal in the medullar with a range of approximately 8 vertebrae. A2 showed a small annular enhancement zone in the center of the lesion. B was enhanced T1WI after 2 weeks of treatment, indicating that the intramedullular annular enhancement zone was not significantly reduced. C1-C2 were images of follow up 3 months of oral fluconazole 400 mg/day. C1 showed a intramedullary hyper intense signal patch, with a longitudinal extent less than 1vertebrae.C2 showed a nodular enhancement area, significantly smaller than before
Fig. 2
Fig. 2
A1-A3 was CT images of lung oftheThoracic Hospital on October 25, 2017, showing multiple spherical lesions in both lungs. Some lesions were closely related to the bronchus (black arrows), and most of the other lesions were randomly distributed. B1-B3 showed the number of lung nodules increased before antifungal treatment. C1-C3 were re-examination after 2 weeks of treatment, showing lesions in the lung significantly reduced. D1-D3 were images follow up 3 months of oral fluconazole 400 mg/d, showing that the lung lesions were further reduced
Fig. 3
Fig. 3
a was a HE stain image of lung biopsy material. Macrophage aggregation (white arrow) was seen, which indicate granulomatous lesions. Round microbes (black arrow) within macrophages were suspected fungi. b showed positive stained round microbes (black arrow) in macrophages with PAS stain, consistent with Cryptococcus
See this image and copyright information in PMC

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