Presentation of Case: Spinal Cord Compression and Cryptococcosis

Abstract

Introduction Cryptococcosis is uncommon in man; preferentially affects pigeon breeders, birders, and laboratory workers. The advent of HIV has significantly increased its frequency. AIDS in adults is the main predisposing factor in over 80% of cases.1 The CDC (Center for Disease Control) in Atlanta states that only 1% of the population under 13 years infected with HIV contracted the disease.3,4 The cryptococcal yeasts are spherical, round, or oval, 3 to 8 mm in diameter; with the capsule, measuring up to 20 µm. They reproduce by budding only; are characterized by a narrow neck between mother and daughter cell. Exceptionally, multiple budding observed with elongated forms and pseudohyphae. The capsule polysaccharide nature is responsible for the virulence of the fungus as it protects against phagocytosis. The size of the yeast varies depending on the strain and culture medium used for isolation.1,2 Marrow cryptococcosis: This clinical form is secondary to the spread of a pulmonary focus, focus meningeal, or both. As in other fungal diseases, cryptococcus has a predilection for bony, skull bones, and vertebrae. In radiology, multiple, discrete, widely scattered, destructive lesions detected chronic evolution.3 The most common symptoms are swelling and pain in the affected area. An isolated bone lesion may be the only manifestation of the disease. There may be periostitis, osteolysis, and osteofibrosis. Occasionally, draining fistulae or mucoid material gave a seropurulent look to the skin.1,2 Material and Methods In this report we presented the case of a young man, with a 4-month history of evolution of back pain that evolves to progressive reduction of muscle strength in lower limbs both, forming a dorsal medullary compression of syndrome, with involvement of the vertebral bodies from D9 to D11 and extrinsic compression, of extradural spinal cord. At biopsy of the lesion, surprising finding performed notes as bone and soft tissue infiltration with yeast Cryptococcus neoformans. We use the clinical history, technique of the surgery, images of MRI, and the pathological report of the biopsy of the patient. Results Pathological result of marrow Cryptococcus neoformans. Conclusion Given the infrequency with which the marrow cryptococcosis occurs, even in immunocompetent individuals, and the few cases reported in the literature on spinal cord compression attributed to it, the therapy becomes complex to make this presentation before. Surgical options in cases of spinal cord compression with marrow cryptococcosis mainly depend on the anatomical site affected and the response to medical treatment. References Rippon JW. Criptococosis. In: Micología Médica. 3rd ed. Interamericana McGraw-Hill 1990:629 Perfect JR. Cryptococcosis. Infect Dis Clin North Am 1989;3(1):77–102 Powderly WG. Cryptococcal meningitis and AIDS. Clin Infect Dis 1993;17(5):837–842 Figueroa DR. Criptococosis meníngea no asociada con VIH. Rev Med IMSS 1999;37:127–132 Littman ML, Borok R. Relation of the pigeon to cryptococcosis: natural carrier state, heat resistance and survival of Cryptococcus neoformans. Mycopathol Mycol Appl 1968;35(3):329–345