title: Spinal intramedullary histoplasmosis as the initial presentation of human immunodeficiency virus infection: case report.
abstract: OBJECTIVE
  Spinal intramedullary histoplasmosis is an extremely rare condition. We report a case of isolated intramedullary histoplasmosis as the initial manifestation of human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  A 27-year-old man presented with a rapidly progressive paraparesis. Magnetic resonance imaging scans revealed an enhancing lesion at C7-T1 with edema extending as far as the cervicomedullary junction. He improved with steroid medications.
  
  
  METHODS
  The patient underwent laminectomy and biopsy of the lesion. The diagnosis of histoplasmosis was made by histology, culture, and polymerase chain reaction identification of fungal deoxyribonucleic acid. The patient did not have disseminated histoplasmosis. Subsequent to the biopsy, the patient was discovered to have HIV infection.
  
  
  CONCLUSIONS
  The isolated spinal histoplasmosis lesion thus represented the initial presentation of HIV infection. Management of the case and diagnostic issues are discussed.
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA. tmanning@u.washington.edu
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Manning
authors.forename: Donald
authors.initials: D
authors.lastname: Born
authors.forename: Trent L
authors.initials: TL
authors.lastname: Tredway
mesh_terms: D000328:Adult; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006660:Histoplasmosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008297:Male; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome