title: Subdural spinal granuloma resulting from Candida albicans without immunosufficiency: case report.
abstract: METHODS
  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.
  
  
  OBJECTIVE
  To clarify the important issues in regard to the diagnosis and treatment of possible spinal subdural granuloma resulting from C. albicans.
  
  
  BACKGROUND
  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-Barré 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedic Surgery, Ehime University School of Medicine, Ehime, Japan. kenshi@m.ehime-u.ac.jp
authors.forename: Kenshi
authors.initials: K
authors.lastname: Sakayama
authors.forename: Teruki
authors.initials: T
authors.lastname: Kidani
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Taketsugu
authors.initials: T
authors.lastname: Fujibuchi
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Takada
authors.forename: Taihoh
authors.initials: T
authors.lastname: Shibata
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D001002:Anuria / Q000209:etiology; D002176:Candida albicans / Q000276:immunology* / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D003937:Diagnosis, Differential; D005682:Gadolinium; D006099:Granuloma / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D020275:Guillain-Barre Syndrome / Q000175:diagnosis; D006801:Humans; D006931:Hyperbaric Oxygenation; D007121:Immunocompetence / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D010243:Paralysis / Q000209:etiology; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013120:Spinal Cord Neoplasms / Q000175:diagnosis; D013131:Spine / Q000601:surgery; D013355:Subdural Space; D013909:Thorax
chemical_list: D002556:Cerebrospinal Fluid Proteins; D005682:Gadolinium