A Rare Presentation of Cauda Equina Syndrome due to Cryptococcosis

Abstract

Introduction: Cauda Equina Syndrome (CES) is a frequently encountered neurological disorder characterized by dysfunction of the sacral nerve roots. Cryptococcosis is a fungal infection caused by exposure to fungi of genus cryptococcus. It most often presents in the pulmonary and central nervous systems. Spinal cryptococcosis is much rarer presentation. Case Description: We present the case of a 51-year-old male with a history of heavy alcohol use presenting with a sudden onset of weakness in his lower extremities and fever after a vacation to Mexico. After undergoing bilateral decompressive laminectomy, durotomy, and partial resection, pathology showed evidence of cryptococcal infection in the cauda equina region. The patient was treated with induction therapy with Amphotericin B and Flucytosine with a good outcome. Conclusion: Cryptococcus neoformans gattii infection caused a mass-like arachnoiditis, without meningoencephalitis, and is the first fungal infection presenting as CES to our knowledge.