Intradural cauda equina Candida abscess presenting with hydrocephalus: case report

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Central nervous system (CNS) candida infections are often associated with a poor prognosis. Typically, CNS candidiasis presents as meningitis or microabscesses. Here, the authors report a patient with a challenging presentation of a CNS Candida infection as a discrete, large cauda equina abscess. The patient initially presented with ventriculomegaly due to fourth ventricular outflow obstruction and a cauda equina mass. The patient was treated with a ventriculoperitoneal shunt and underwent a lumbar laminectomy for exploration of the lumbar lesion. An intradural abscess was encountered during surgery. Fungal wet mount revealed fungal elements and polymerase chain reaction confirmed the presence of Candida albicans. The patient did not have any known predisposition to fungal infections; therefore, the authors performed whole-exome sequencing using peripheral blood mononuclear cell DNA. They found heterozygous missense variants in the following genes: colony-stimulating factor 2 (CSF2) and Ras protein-specific guanine nucleotide-releasing factor 1 (RASGRF1)—genes that have been specifically associated with protection from CNS candidiasis via caspase recruitment domain-containing protein 9 (CARD9) signaling, and phospholipase C gamma 2 (PLCG2)—a lectin receptor involved in candidiasis. The authors’ experience suggests that C. albicans can present as a cauda equina abscess. Hydrocephalus, a result of diffuse arachnoiditis, is a potential complication from intradural fungal abscesses.

ABBREVIATIONS CARD9 = caspase recruitment domain-containing protein 9; CNS = central nervous system; CRP = C-reactive protein; CSF2 = colony-stimulating factor 2; PLCG2 = phospholipase C gamma 2; RASGRF1 = Ras protein-specific guanine nucleotide-releasing factor 1.
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Correspondence John D. Heiss: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD. heissj@ninds.nih.gov.INCLUDE WHEN CITING Published online August 30, 2019; DOI: 10.3171/2019.6.SPINE19271.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Chen GHTeitz-Tennenbaum SNeal LMMurdock BJMalachowski ANDils AJ: Local GM-CSF-dependent differentiation and activation of pulmonary dendritic cells and macrophages protect against progressive cryptococcal lung infection in mice. J Immunol 196:181018212016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Decker BMNoyes CDRamundo MBThomas AA: Fungal cauda equina lesion with delayed cord compression and treatment response. Clin Neurol Neurosurg 174:1851862018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Gavino CHamel NZeng JBLegault CGuiot MCChankowsky J: Impaired RASGRF1/ERK-mediated GM-CSF response characterizes CARD9 deficiency in French-Canadians. J Allergy Clin Immunol 137:11781188.e72016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Lek MKarczewski KJMinikel EVSamocha KEBanks EFennell T: Analysis of protein-coding genetic variation in 60,706 humans. Nature 536:2852912016

  • 5

    Mendes VCastro SLinhares PRibeiro-Silva ML: Tumoriform presentation of cerebral candidiasis in an HIV-infected patient. J Clin Neurosci 16:5875882009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Merwick ÁMinhas ZCurtis CThom MChoi DMummery C: Intradural extramedullary spinal candida infection. Pract Neurol 15:4004042015

  • 7

    Neves NSantos LReis CSarmento A: Candida albicans brain abscesses in an injection drug user patient: a case report. BMC Res Notes 7:8372014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Sánchez-Portocarrero JPérez-Cecilia ECorral ORomero-Vivas JPicazo JJ: The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis 37:1691792000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Stevens DAShatsky SA: Intrathecal amphotericin in the management of coccidioidal meningitis. Semin Respir Infect 16:2632692001

  • 10

    Taylor PRTsoni SVWillment JADennehy KMRosas MFindon H: Dectin-1 is required for β-glucan recognition and control of fungal infection. Nat Immunol 8:31382007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Xu SHuo JLee KGKurosaki TLam KP: Phospholipase Cγ2 is critical for Dectin-1-mediated Ca2+ flux and cytokine production in dendritic cells. J Biol Chem 284:703870462009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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