Cryptococcal spinal arachnoiditis.

Infection of the central nervous system by Cryptococcus neoformans has been reported in the medical literature often enough to be now widely recognized as one of the causes of chronic meningitis. The symptoms and signs emphasized include headache, vomiting, papilloedema, progressive blindness, hemiplegia, and alterations of mental status. Cryptococcal meningitis is commonly associated with pre-existing diabetes mellitus, Hodgkin's disease, sarcoidosis, and corticosteroid therapy. Several reviews have described the clinical manifestations, laboratory data and therapy of the meningitis (Mosberg and Arnold, 1950; Rose, Grant, and Jeanes, 1958; Littman, 1959; Fitzpatrick and Poser, 1960; Butler, Alling, Spickard, and Utzh, 1964) Although there have been many reports describing cryptococcal meningitis, mention of involvement of the spinal cord in these cases is quite rare. In 1951 Carton and Mount reported one case of a spinalcord cryptococcal granulomatous mass and reviewed the literature, finding 10 cases with spinal cord involvement. Three of these cases demonstrated spinal cord symptoms clinically. In the remaining cases the spinal cord lesions were discovered coincidentally at necropsy. In the same year, Ley, Jacas, and Oliveras (1951) reported on their successful removal of a cervical spinal cord cryptococcal granulomatous mass, with excellent recovery of the patient. Spinal arachnoiditis (Elkington, 1951) is a wellestablished syndrome, often difficult to diagnose clinically, with various and usually ill-defined aetiologies. Review of the literature in English does not reveal arachnoiditis as a specific clinical manifestation of cryptococcal infection of the central nervous system. This paper describes a patient with cryptococcal spinal arachnoiditis without intracranial symptoms or signs, diagnosed by biopsy, who was successfully treated with intravenous amphotericin-B. The purpose of this report is to present a probable previously undescribed complication of Cryptococcus infection of the central nervous system, and to emphasize the importance of fully investigating patients suspected of spinal