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

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.

Cryptococcal infection causing longitudinal extensive transverse myelitis in an immunocompetent individual: Case report and literature review

“…He was put on consolidation therapy and is currently on maintenance therapy and has completely recovered on follow up. Others’ studies ( 4 , 8 , 9 ) also showed that correct diagnosis and prompt treatment results in 90% of patients showing complete recovery. This highlights the notion that if there are clinical pointers toward an infective etiology in case of a LETM, one should rule out cryptococcus CNS infection as it is a treatable condition ( 18 ).…”

“…Overall, in cases of cryptococcal myelitis the median duration of onset of symptoms prior to admission was 38 days (IQR 9.5, 90). In the three cases of LETM reported in literature the duration of symptoms was 5, 10, and 150 days, respectively, ( 4 , 8 , 9 ). In our case, the patient had a four-day history of weakness prior to admission.…”

“…These manifestations have been reported in immunocompetent patients ( 1 , 2 ). Transverse myelitis as a presenting feature of CNS cryptococcal infection has also been reported in literature ( 3 ) but longitudinal extensive transverse myelitis has been rarely reported ( 4 ). Herein, we report a 48-year-old immunocompetent male presenting with LETM due to cryptococcal infection, who regained normal functional status following treatment.…”