Spinal intramedullary histoplasmosis as the initial presentation of human immunodeficiency virus infection: case report.
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.
Manning
Thomas C
TC
Department of Neurological Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA. tmanning@u.washington.edu
Born
Donald
D
Tredway
Trent L
TL
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