PMC8247672_01
Preoperative magnetic resonance imaging. (a) Coronal gadolinium-enhanced image, (b) sagittal gadolinium-enhanced image, (c) axial T2/FLAIR-weighted image showing a slight reduction in the thickness of the leptomeningeal impregnation of the lateral fissures and frontotemporal operculum on both sides suggestive of diffuse pachymeningitis.
SNI-12-275-g001.jpg
PMC8247672_01_SNI-12-275-g001.jpg
F1
Brain MRI showed thickening and leptomeningeal impregnation by gadolinium compromising both lateral fissures, insula, and frontotemporal operculum, evidencing diffuse pachymeningitis [Figure 1].
Preoperative magnetic resonance imaging. (a) Axial T2/STIR-weighted image, sagittal T1 and T2/STIR-weighted image, (c) sagittal T2/STIR-weighted showing the intramedullary abscess hypointense on images (a and b) and hyperintense on image (c).
SNI-12-275-g002.jpg
PMC8247672_01_SNI-12-275-g002.jpg
F2
The MRI of the spine showed marked diffuse leptomeningeal enhancement along the anterior and posterior pial surfaces of all medullary segments, as well as medullary cone, marked segmental narrowing of the medulla at T10-T11 levels with hypersignal in the weighted sequences at T1 and T2/STIR associated with the tumefactive effect of the cone spinal cord with intramedullary lesion at this level, hypointense in T1-weighted image and hyperintense in T2/STIR weighted [Figure 2].
Intramedullary abscess drainage surgery.
SNI-12-275-g003.jpg
PMC8247672_01_SNI-12-275-g003.jpg
F3
A T10-T11 laminectomy was performed and, after straight opening of the dura mater, a whitish lesion was found in the intramedullary region, suggestive of an abscess, being, therefore, drained and biopsied for analysis [Figure 3].
Histopathology revealed numerous septate pseudohyphae and fungal spores embedded in fibrinoid material (a, H and E, x400). There was intense silver impregnation by Grocott methenamine silver stain, suggestive of Candida albicans (b, GMS, x400).
SNI-12-275-g004.jpg
PMC8247672_01_SNI-12-275-g004.jpg
F4
The culture of the surgical specimen tested positive for C. albicans and the histopathological evaluation of the lesion revealed extensive fibrinoid material and presence of hyaline septate pseudohyphae and fungal spores, with strong impregnation by Grocott methenamine silver stain [Figure 4].