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Argersinger DP, Natkha VP, Shepard MJ, et al. Intradural cauda equina Candida abscess presenting with hydrocephalus: case report. J Neurosurg Spine. 2019;1-4doi: 10.3171/2019.6.SPINE19271.
Argersinger, D. P., Natkha, V. P., Shepard, M. J., Thomas, A. A., Oler, A. J., Williamson, P. R., Chittiboina, P., & Heiss, J. D. (2019). Intradural cauda equina Candida abscess presenting with hydrocephalus: case report. Journal of neurosurgery. Spine, 1-4. https://doi.org/10.3171/2019.6.SPINE19271
Argersinger, Davis P, et al. "Intradural cauda equina Candida abscess presenting with hydrocephalus: case report." Journal of neurosurgery. Spine vol. (2019): 1-4. doi: https://doi.org/10.3171/2019.6.SPINE19271
Argersinger DP, Natkha VP, Shepard MJ, Thomas AA, Oler AJ, Williamson PR, Chittiboina P, Heiss JD. Intradural cauda equina Candida abscess presenting with hydrocephalus: case report. J Neurosurg Spine. 2019 Aug 30;1-4. doi: 10.3171/2019.6.SPINE19271. Epub 2019 Aug 30. PMID: 31470401; PMCID: PMC7339489.
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J Neurosurg Spine. 2019 Aug 30;1-4. doi: 10.3171/2019.6.SPINE19271. Epub 2019 Aug 30.

Intradural cauda equina Candida abscess presenting with hydrocephalus: case report.

Journal of neurosurgery. Spine

Davis P Argersinger, Vitaliy P Natkha, Matthew J Shepard, Alissa A Thomas, Andrew J Oler, Peter R Williamson, Prashant Chittiboina, John D Heiss

Affiliations

  1. 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
  2. 2Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas.
  3. 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
  4. 4University of Vermont Medical Center, Department of Neurological Sciences, Burlington, Vermont.
  5. 5Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, and.
  6. 6Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and.
  7. 7Neurosurgery Unit for Pituitary and Inheritable Disorders, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.

PMID: 31470401 PMCID: PMC7339489 DOI: 10.3171/2019.6.SPINE19271

Abstract

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.

Keywords: CARD9 = caspase recruitment domain-containing protein 9; CNS = central nervous system; CRP = C-reactive protein; CSF2 = colony-stimulating factor 2; Candida albicans; PLCG2 = phospholipase C gamma 2; RASGRF1 = Ras protein-specific guanine nucleotide-releasing factor 1; hydrocephalus; immunosuppression; infection; intradural spinal abscess

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