Fungal Infections : Study From Japan
Sakayama K, Kidani T, Matsuda Y, Fujibuchi T, Miyazaki T, Takada K, Shibata T, Yamamoto H.
Departments of Orthopedic Surgery,; Pathology, and; Internal Medicine, Ehime University School of Medicine, Ehime, Japan.
STUDY DESIGN:
This was a case of spinal subdural granuloma of Candida albicans. A high cerebrospinal fluid protein level without pleocytosis (albuminocytologic dissociation) was observed. This case proved difficult to diagnose and treat.
OBJECTIVES:
To clarify the important issues in regard to the diagnosis and treatment of possible spinal subdural granuloma resulting from C. albicans.
SUMMARY OF BACKGROUND DATA:
Reports on subdural infection of C. albicans are very rare. Moreover, there are no reports of cases in which patients have survived this type of infection.
METHODS:
A 66-year-old man developed paralysis in the lower limbs, as well as vesicorectal disorder (anuresis). There were no obvious causes. Signs of meningeal irritation later appeared. A high cerebrospinal fluid protein level without pleocytosis was observed through a laboratory test. The cause of these disorders was unclear, and a final diagnosis could not be made on the basis of the test results and angiograph. Possible diagnoses included tumor, infection, and others such as Guillain-Barre syndrome. The authors therefore carried out surgery to reduce the pressure on the spinal cord and ultimately make a definitive diagnosis.
RESULTS:
The final diagnosis was spinal subdural granuloma of C. albicans. Granuloma was widespread (T3-T10). Surgery, various drug treatments, and hyperbaric oxygen therapy all contributed to saving the patient's life.
CONCLUSION:
This was a very rare case of spinal subdural granuloma resulting from C. albicans, and the authors had difficulty diagnosing and treating the patient. A distinctive gadolinium-enhanced MRI was obtained. The effect of treatment by drugs alone was limited. An intraoperative ultrasonography proved useful. The authors concluded that a combination of early surgery and hyperbaric oxygen therapy was effective.
PMID: 12163736 [PubMed - in process]
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