Lumbar cistern Candida intradural abscess following epidural anesthesia

Abstract

Background: This report describes a case of an immunocompetent patient with an intradural abscess from Candida dubliniensis. The majority of fungal spine infections, although rare in general, are due to Aspergillus or C. albicans through systemic fungemia. To date, there have only been two reports of spondylodiscitis from C. dubliniensis.

Case description: A 37-year-old immunocompetent female patient presented to the neurosurgical service for worsening headaches with nausea, vomiting, vision changes, and weight loss. MRI studies showed diffuse leptomeningeal enhancement of the distal spinal cord, conus medullaris, and nerve roots of the cauda equina extending beyond the neural foramina bilaterally. She had persistent symptoms and no clear diagnosis on lumbar puncture or systemic testing therefore L5-S1 laminectomy for an intradural tissue biopsy was performed. During surgery, cultures were taken and grew colonies of C. dubliniensis.

Conclusion: This organism has been reported rarely in the literature as being an infectious agent, thus diagnosing remains a challenge but should be considered in patients with a suggestive history.

Keywords: Candida dubliniensis; Cauda equina; Intradural abscess; Spinal abscess.

Figure 1:

Intradural and leptomeningeal enhancement medullaris, sagittal T1 fat suppressed with contrast.

Figure 2:

Enhancing nerve roots of the cauda equina, axial T1 with contrast.

Figure 3:

Thickening and enhancement at the lower lumbosacral spinal canal (from approximately L4 to L5 through the S2 levels), sagittal T2.

Figure 4:

Soft-tissue collection demonstrating diffuse heterogeneous enhancement and marked restriction within the thecal sac, isotropic (diffusion-weighted imaging).

Figure 5:

Gomori methenamine silver stain showing hyphal forms, original magnification ×400.

Figure 6:

Hematoxylin and eosin stain showing necrosis, original magnification ×400.