Intramedullary histoplasmosis of the thoracic cord as an isolated lesion: A rare case report and literature review

Abstract

Background: Disseminated histoplasmosis involving the central nervous system occurs in 5–10% of cases. However, intramedullary spinal cord lesions are extremely rare. Here, 45-year-old female with a T8–9 intramedullary lesion did well following surgical extirpation. Case Description: For 2 weeks, a 45-year-old female experienced progressive lower back pain, paresthesias, and paraparesis. The magnetic resonance imaging showed an intramedullary expansive lesion at the T8–T9 level that markedly enhanced with contrast. Surgery, consisting of T8–T10 laminectomies performed using neuronavigation, an operating microscope, and intraoperative monitoring, revealed a well-demarcated lesion that proved to be a focus of histoplasmosis; it was readily completely excised. Conclusion: Surgery is the gold standard for treating spinal cord compression attributed to intramedullary histoplasmosis unresponsive to medical management.