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Case 1


Leptomeningeal exudate with progressive neurological deterioration
Final Diagnosis
Gross and microscopic images - click on image to view full-size
Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11
The differential diagnosis included leptomeningeal carcinomatosis (figure 6), bacterial meningitis (figure 7), herpes simplex encephalitis (figure 8), and sarcoidosis (figure 9), none of which were identified.

Candida albicans is a common fungal commensurate, which may become pathogenic especially in immunosuppressed individuals. In the central nervous system it usually manifests as multiple abscesses (figure 10 & figure 11), but occasionally presents with leptomeningitis as in this patient. Subsequent to autopsy a history of candidemia secondary to an infected central line at another institution was revealed. This had occurred about a year before neurological presentation. Although the organism was not cultured in our institution, it is presumed to have been responsible for the observed fungal meningitis.



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© 2002,2004 Chevonne Lyons, digital neuro images: © 2002, 2004 Dr. Rob Macaulay - Halifax, Nova Scotia, Canada
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