Teaching NeuroImages Neurology Resident and Fellow Section Spherules in Spine: Vertebral Coccidioidomycosis © 2014 American Academy of Neurology.

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Presentation transcript:

Teaching NeuroImages Neurology Resident and Fellow Section Spherules in Spine: Vertebral Coccidioidomycosis © 2014 American Academy of Neurology

VIGNETTE 39 YEAR OLD MALE PRESENTING WITH DESCENDING PARALYSIS Dubey et al © 2014 American Academy of Neurology

Imaging Dubey et al © 2014 American Academy of Neurology

Spherules in Spine: Vertebral Coccidioidomycosis 39 year-old African-American immunocompetent man with frequent travels to Mexico presented with progressive descending weakness over 2 weeks. Physical examination revealed chest ulcers, cervical lymphadenopathy, spastic quadriparesis, decreased sensation to touch and pain up to C7 dermatome, hyper-reflexia, bilateral positive Hoffman’s and Babinski’s sign. MRI of the spine showed multilevel osteomyelitis and paraspinal abscesses involving the cervical and thoracic regions (Image A). He underwent surgical debridement. Vertebral biopsy showed necrotizing, granulomatous inflammation and numerous thick-walled spherules (Image B). Culture confirmed coccidioidomycosis. Patient was initiated on amphotericin B for 6 weeks, followed by fluconazole and showed gradual clinical improvement [1]. Dubey et al © 2014 American Academy of Neurology