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April 1982

Spinal Cord Compression by Coccidioides immitis Abscess

Author Affiliations

From the Department of Neurology, University of Texas Medical Branch, Galveston. Dr Delaney is now at the Audie L. Murphy Veterans Administration Hospital, San Antonio, Tex.

Arch Neurol. 1982;39(4):255-256. doi:10.1001/archneur.1982.00510160061015

Meningitis is the most common form of CNS involvement with Coccidioides immitis, occurring exclusively in those patients with disseminated disease.1 A rare form is spinal cord compression from vertebral or epidural coccidioidal granuloma.2-8 We describe a patient with disseminated coccidioidomycosis that mimicked a lymphoma with bony metastases and thoracic myelopathy.

REPORT OF A CASE  A 23-year-old man was referred to us because of respiratory distress and leg weakness. For five months he had complained of progressive leg weakness associated with unrelenting midthoracic back pain, anorexia, and weight loss. The patient was febrile and in marked respiratory distress. A large right supraclavicular lymph node was felt, and rales were heard throughout both lung fields. Neurologic examination revealed a mild encephalopathy and moderate spastic paraparesis with extensor plantar responses. A chest roentgenogram documented diffuse reticulonodular infiltrates and a right paratracheal mass. Multiple lytic lesions were seen in the pelvic bones

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