Cryptococcal spinal arachnoiditis.

Infection ofthecentral nervous system byCryptococcus neoformans hasbeenreported inthemedical literature often enough tobenowwidely recognized asoneofthecauses ofchronic meningitis. The symptoms andsigns emphasized include headache, vomiting, papilloedema, progressive blindness, hemiplegia, andalterations ofmental status. Cryptococcal meningitis iscommonlyassociated with pre-existing diabetes mellitus, Hodgkin's disease, sarcoidosis, andcorticosteroid therapy. Several reviews havedescribed theclinical manifestations, laboratory dataandtherapy ofthemeningitis (Mosberg andArnold, 1950; Rose,Grant, and Jeanes, 1958; Littman, 1959; Fitzpatrick andPoser, 1960; Butler, Alling, Spickard, andUtzh, 1964) Although there havebeenmanyreports describing cryptococcal meningitis, mention ofinvolvement of thespinal cordinthese casesisquite rare. In1951 CartonandMountreported onecaseofaspinalcordcryptococcal granulomatous massandreviewed theliterature, finding 10caseswithspinal cord involvement. Threeofthese casesdemonstrated spinal cordsymptomsclinically. Intheremaining casesthespinal cordlesions were discovered coincidentally atnecropsy. Inthesameyear, Ley, Jacas, andOliveras (1951) reported ontheir successfulremoval ofacervical spinal cordcryptococcal granulomatous mass,withexcellent recovery ofthe patient. Spinal arachnoiditis (Elkington, 1951) isa wellestablished syndrome, oftendifficult todiagnose clinically, withvarious andusually ill-defined aetiologies. Review oftheliterature inEnglish does notreveal arachnoiditis asaspecific clinical manifestation ofcryptococcal infection ofthecentral nervous system. Thispaperdescribes apatient with cryptococcal spinal arachnoiditis withoutintracranial symptoms orsigns, diagnosed bybiopsy, who was successfully treated withintravenous amphotericin-B. Thepurpose ofthisreport isto present a probable previously undescribed complication ofCryptococcus infection ofthecentral nervous system, andtoemphasize theimportance of fully investigating patients suspected of spinal *Reprint requests to4900Sunset Boulevard, LosAngeles, California 90027, U.S.A.