An Almost Crypto(genic) Cause of Radiculopathy (P01.253)

Objective: We describe a rare case of non-HIV/AIDS related cryptococcal neurological infection with a very unusual presentation in the form of a radiculopathy. Background Cryptococcal Neurological infections have been well described in patients who are immunocompromised secondary to HIV/AIDS but less well described in patients immunocompromised secondary to other etiologies. Design/Methods: Our patient is was a 70 year old right handed man with myelodysplastic syndrome, on chemotherapy and platelet transfusion-dependent who presented with acute onset of left leg weakness. Seven days prior to presentation he developed numbness and tingling in his left leg following a fall, which progressed over an hour into left lower extremity weakness with inability to ambulate without a walker. Also, he had intermittent diffuse headache and episodic confusion. On neurological examination, his left lower extremity power was (3/5), absent left patellar reflex, diminished sensation in the left lower extremity below the knee. He underwent a head CT, MRI of the cervical, thoracic and lumbar spine were significant for degenerative changes of the vertebra most prominent at C3-C4, a small posterior disc bulge T8-T9 with no cord compression and pelvic MRI which was negative for retroperitoneal hemorrhage; a normal EEG; EMG was consistent with a subacute left high lumbar through L4 radiculopathy with active denervation. CSF analysis revealed a lymphocytoc pleocytosis with low glucose (16) and elevated protein (146) with 2+ yeast on gram stain and he was initiated on ambisome for presumed fungal meningitis. Serum cryptococcal antigen was negative. CSF cryptococcal antigen was positive with a titer of 1:4096. Results: Our patient was discharged on long-term ambisome infusions with little recovery in the function of his left leg. Conclusions: Cryptococcal neurological infections need to be considered in patients with other underlying immunocompromised states besides HIV/AIDS so that appropriate therapy can be instituted in a timely manner. Disclosure: Dr. Goldstein has nothing to disclose. Dr. Dangayach has nothing to disclose. Dr. Riley has received personal compensation for activities with Allergan, Ipsen, Lundbeck, Merz and Teva as a consultant.Dr. Riley has received research support from Cleveland Medical Devices.