SPINAL INTRATHECAL ACTINOMYCOSIS - A CASE-REPORT

BACKGROUND Actinomycosis of the central nervous system is a rare disea se that most frequently forms cerebral abscesses. In the present repor t, we describe an extremely rare case of spinal intrathecal actinomyco sis. CASE PRESENTATION A 33-year-old man presented with high fever fol lowed by back pain and paraparesis. Magnetic resonance imaging (MRI) w ith gadolinium-diethylene-triamine penta-acetic acid (Gd-DTPA) enhance ment (Gd-MRI) displayed an irregularly enhanced mass lesion at the tho raco-lumbar junction that mimicked an intramedullary tumor with exophy tic growth. Surgical exploration 7 months after the onset of the high fever revealed intrathecal granulation tissue with small abscess forma tion. Another surgical exploration was carried out 2 months after the first operation because the patient developed progressive paraparesis and showed an intrathecal ring-like enhancement that was detected with Gd-MRI. Actinomyces organisms were finally identified histologically in the surgical specimen. CONCLUSIONS The clinical course and serial c hanges of Gd-MRI findings are important considerations when this rare and infectious spinal lesion is suspected. (C) 1998 by Elsevier Scienc e Inc.