Hott Jonathan S, Horn Eric, Sonntag Volker K H, Coons Stephen W, Shetter Andrew
Divisions of Neurologic Surgery, Barrow Neurologic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
J Spinal Disord Tech. 2003 Apr;16(2):212-5. doi: 10.1097/00024720-200304000-00016.
An immunocompetent patient from a nonendemic region developed a rare intramedullary thoracic histoplasmoma. A native Arizonan, with no history of travel to endemic regions, received 3 months of itraconazole for confirmed gastrointestinal histoplasmosis at an outside institution. Two years later she experienced the rapid onset of paraplegia and lost bowel and bladder function. Magnetic resonance imaging demonstrated a ring-enhancing intramedullary lesion at T2 and signal abnormality from C2 to T5. Emergent T2-T3 laminectomy was performed with ultrasonographically guided intradural exploration and midline myelotomy. The intramedullary abscess was drained. She was nonambulatory, but motor function was partially restored. An Ommaya reservoir was later placed to deliver amphotericin and a new antifungal agent, voriconazole. Magnetic resonance imaging confirmed that the infection had resolved. Intramedullary spinal histoplasmoma is a rare manifestation of disseminated histoplasmosis, particularly in nonendemic regions. Surgery for focal mass lesions and aggressive antifungal chemotherapy are the optimal treatment. Newer central nervous system-penetrating antibiotics show promise in refractory cases.
一名来自非疫区的免疫功能正常患者患上了罕见的胸段髓内组织胞浆菌病。一名土生土长的亚利桑那州人，无前往疫区的旅行史，曾在外地机构因确诊为胃肠道组织胞浆菌病接受了3个月的伊曲康唑治疗。两年后，她迅速出现截瘫，并丧失了肠道和膀胱功能。磁共振成像显示T2水平有一个环形强化的髓内病变，且从C2到T5有信号异常。紧急进行了T2 - T3椎板切除术，并在超声引导下进行硬膜内探查和中线脊髓切开术。排出了髓内脓肿。她无法行走，但运动功能部分恢复。后来放置了一个Ommaya储液器，用于输注两性霉素和一种新的抗真菌药物伏立康唑。磁共振成像证实感染已消退。髓内脊髓组织胞浆菌病是播散性组织胞浆菌病的一种罕见表现，尤其是在非疫区。针对局灶性肿块病变进行手术和积极的抗真菌化疗是最佳治疗方法。新型能穿透中枢神经系统的抗生素在难治性病例中显示出前景。
