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
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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.
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