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Hyperin Tensity of Spinal Cryptococcus Infection on DWI 2004

Rumboldt, Zoran, M.D., Aganovic, Lejla, M.D. Hoda, Rana, M.D.

Excerpta:
A 20-year-old African American male presented to our institution with 2-month history of progressive low back and flank pain. There were no neurological deficits on clinical exam. Past medical history was significant for pulmonary sarcoidosis for which he was self medicated with prednisone.
MRI on the lumbar spine demonstrated destructive lesions involving L1 and L2 vertebral bodies, as well as T12 and L1 posterior elements. The abnormalities were also identified in the paraspinal muscles and posterior epidural space from T12 to L3 levels. The mass was spreading along the L1-L2 neural foramen into the right psoas muscle, and minimal involvement of T12-L1 disk was observed. Post co ntrast images showed several rim enhancing areas in the epidural space and paraspinal muscles. Diffusion weighted images (DWI) were also performed and showed prominent hyperintesity of the lesions. This multifocal, multilevel distribution involving vertebrae, epidural space and surrounding muscles as well as relative sparing of disk space was considered indicative of a granulomatous spinal infection.

CT guided biopsy was then performed, and preliminary pathology report was consistent with sarcoidosis. Additional stainings demonstrated Cryptococcus neoformans infection. Patient was placed into brace and subsequently treated with antimycotic medications, followed by complete recovery without any neurological sequelae.

We propose that lesion hyperintensity on DWI, indicating severe restriction of diffusion, may be characteristic for infectious processes of the spine, similar to intracranial lesions.