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Case report
Isolated leptomeningeal carcinomatosis and possible fungal meningitis as late sequelae of oesophageal adenocarcinoma
  1. Richard Dumbill1,
  2. Sanja Thompson2,
  3. Heiko Peschl3,
  4. GDH Turner4 and
  5. Charles Woodrow5
  1. 1 General Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Clinical Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Cardiothoracic Radiology and Emergency Imaging, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4 Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  5. 5 Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Richard Dumbill; richard.dumbill{at}doctors.org.uk

Abstract

We describe a case of a 67-year-old man with known chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, osteoarthritis, previous history of excess alcohol intake, and oesophagectomy 3 years earlier for T3N0 adenocarcinoma, referred by his general practitioner with confusion, weight loss and several recent falls. CT of the chest, abdomen and pelvis revealed a right middle-lobe pulmonary embolism, while CT of the head revealed a communicating hydrocephalus. Lumbar puncture was performed, and empirical treatment for tuberculous and fungal meningitis was commenced. Unfortunately, he suffered a rapid neurological deterioration with markedly elevated cerebrospinal fluid (CSF) pressures, leading to an external ventricular drain. Cytological analysis of a CSF sample revealed a cellular infiltrate consistent with leptomeningeal carcinomatosis (adenocarcinoma), with the previous oesophageal malignancy the likely primary. He passed away 17 days after hospital admission. Prolonged culture of CSF later produced evidence of two distinct phaeomycotic moulds (Cladosporium sp and Exophiala sp), suggesting that fungal meningitis may also have contributed to the clinical picture.

  • meningitis
  • oesophageal cancer
  • pathology
  • surgical oncology
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Footnotes

  • Contributors RD conceived and coordinated the project, and wrote the report. ST provided interpretation of the clinical data and redrafted the report. HP acquired the radiological images, provided an interpretation and wrote this part of the report. GT performed the cytological analysis and wrote this part of the report. CW provided an interpretation of the microbiological data, including acquiring a Public Health England report on the mycology, and wrote the microbiological aspects of the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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