Jennifer L. Lyons, MD; Elakkat D. Gireesh, MD; Julie B. Trivedi, MD; W. Robert Bell, MD; Deanna Cettomai, MD; Bryan R. Smith, MD; Sarah Karram, MD; Tiffany Chang, MD; Laura Tochen, MD; Sean X. Zhang, MD, PhD; Chad M. McCall, MD, PhD; David T. Pearce, BS; Karen C. Carroll, MD; Li Chen, MD, PhD; John N. Ratchford, MD, MSc; Daniel M. Harrison, MD; Lyle W. Ostrow, MD, PhD; Robert D. Stevens, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2577.
This article was published at www.annals.org on 17 October 2012.
Lyons JL, Gireesh ED, Trivedi JB, Bell WR, Cettomai D, Smith BR, et al. Fatal Exserohilum Meningitis and Central Nervous System Vasculitis After Cervical Epidural Methylprednisolone Injection. Ann Intern Med. 2012;157:835-836. doi: 10.7326/0003-4819-158-1-201212040-00557
Download citation file:
Published: Ann Intern Med. 2012;157(11):835-836.
Brain and neck MRI and histopathologic findings from a patient with Exserohilum leptomeningitis and stroke.
Axial diffusion-weighted imaging from hospital days 4 (A) and 7 (B) shows progression of pontine infarction (arrows). Axial T2-weighted fluid attenuated inversion recovery imaging from hospital days 4 (C) and 7 (D) similarly shows disease progression as indicated by increasing hyperintensity in the midbrain (arrows) and interval development of ventriculomegaly secondary to brainstem edema (asterisks). Additional infarctions with similar evolution were located in the medulla and cerebellar hemispheres (not shown). Coronal T1 imaging after the administration of intravenous gadolinium on hospital day 7 (E) shows diffuse leptomeningeal enhancement (arrows) and ventriculomegaly (asterisks). Axial T2-weighted short tau inversion recovery imaging (F) and T1-weighted imaging after the administration of intravenous gadolinium (G) of the neck show hyperintensity and abnormal enhancement in cervical paraspinal muscles at the epidural steroid injection site, suggesting subcutaneous edema and possible infected fluid collection (arrows). Postmortem hematoxylin–eosin stain of the right middle cerebral artery (H) shows abundant septate fungal hyphae penetrating the vessel (arrowheads) with concomitant acute inflammatory response. MRI = magnetic resonance imaging.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only