A 27-year-old previously healthy migrant farm worker presented with progressive bilateral lower extremity weakness that had developed during the preceding month. His physical examination results were notable for bilateral lower extremity weakness (right greater than left), clonus in the right foot, diminished sensation to pinprick from T9 through S1 bilaterally, and incontinence of bowel and bladder. He was also noted to have superficial white onychomycosis on multiple digits (Figure 1).
Bollyky PL, Czartoski TJ, Limaye A. Histoplasmosis Presenting as an Isolated Spinal Cord Lesion. Arch Neurol. 2006;63(12):1802-1803. doi:10.1001/archneur.63.12.1802