title: Rapidly progressive quadriparesis heralding disseminated coccidioidomycosis in an immunocompetent patient.
abstract: Coccidioides species are dimorphic fungi endemic to southwestern USA and northern Mexico. Disseminated coccidioidomycosis is rare with an estimated incidence of 1% in affected individuals and usually presents as meningitis when the central nervous system is involved. Spinal involvement with coccidioidomycosis, though not uncommon, predominantly manifests as osseous involvement leading to osteomyelitis and epidural abscess formation. Progressive quadriparesis as a presenting symptom secondary to intramedullary spinal cord coccidioidomycosis is very unusual and to our knowledge has not been described. We report a patient with disseminated coccidioidomycosis who presented with rapidly progressive quadriparesis due to cervical intramedullary spinal cord involvement. The absence of known coccidioidomycosis with atypical clinical presentation made the diagnosis elusive, requiring emergent cervical laminectomies with dural biopsy for decompression of the spinal cord and confirmation of the diagnosis. The patient eventually succumbed to the progressive course of the disease. Although rare, disseminated coccidioidomycosis can present as new, rapidly progressing quadriparesis in patients who have traveled to endemic areas. A high index of suspicion in such patients with appropriately directed laboratory investigations and consideration of early biopsy might unravel the diagnosis facilitating early antifungal treatment with the potential to minimize morbidity and mortality associated with disseminated coccidioidomycosis.
authors: Department of Neurosurgery, Rush University Medical Center, Suite 855, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
authors: Lee A
authors: LA
authors: Tan
authors: Department of Neurosurgery, Rush University Medical Center, Suite 855, 1653 W. Congress Parkway, Chicago, IL 60612, USA. Electronic address: manish_kasliwal@rush.edu.
authors: Manish K
authors: MK
authors: Kasliwal
authors: Department of Pathology, Rush University Medical Center, Chicago, IL, USA.
authors: Sukriti
authors: S
authors: Nag
authors: Department of Neurosurgery, Rush University Medical Center, Suite 855, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
authors: John E
authors: JE
authors: O'Toole
authors: Department of Neurosurgery, Rush University Medical Center, Suite 855, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
authors: Vincent C
authors: VC
authors: Traynelis
mesh_terms: D003047:Coccidioidomycosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D018450:Disease Progression; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D013997:Time Factors
keywords: Coccidioides; Disseminated coccidioidomycosis; Fungal infection; Intramedullary; Quadriparesis; Spine