Cervical Intradural Fungal Infection Masquerading as a Meningioma in an Immunocompetent Patient: A Case Report and Systematic Review

Abstract

Background

Intradural spinal fungal infection is a rare phenomenon that can carry a significant increase in morbidity and mortality. This systematic review and case report provides a presentation of a 75-year-old male patient with an intradural cervical mass that was diagnosed as a fungal infection intraoperatively. We analyze and report on intradural spinal fungal infections in immunocompetent patients.

Methods

We performed a systematic literature review following the PRISMA protocol for studies of intradural fungal infections published in the past 25 years. Original articles with a description of treatment outcomes of such patients were included.

Results

A total of 8 studies were included in this review with the addition of the present case. There were 5 male and 4 female patients with an average age of 45.6 yeaers (range 24–75 years). Aspergillus and Candida species being the most isolated fungal organism. The origin of the lesions was identified and iatrogenic in 4 cases. Most patients underwent decompressive laminectomy with biopsy, abscess drainage, or resection of the identified lesion. There were 2 instances of cervical lesions, but most of the lesions were in the thoracic and lumbar spine. Half of the cases reported symptoms improvement, but 2 patients died from the infection or complications from the infections.

Conclusions

Intradural fungal infections are rare, with only 10 total cases reported in the past 25 years. Nonetheless, they can be associated with significant mortality and morbidity. Thus, the timeline from presentation to intervention should be evaluated and determined carefully.