Man-in-the-barrel syndrome caused by cervical arachnoiditis in refractory coccidioidal meningitis.

Sophia Marie Pelayo Tran, Tanya Savenka, Kwan L Ng, George R Thompson

Abstract readCase Reports

In one paragraph

Article in Medical mycology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

4 authors.

Sophia Marie Pelayo TranUniversity of California Davis Medical School, Sacramento, CA, USA.

Tanya SavenkaDivision of Infectious Diseases, Department of Medicine, University of California Davis, Medical Center, Sacramento, CA, USA.

Kwan L NgDepartment of Neurology, University of California Davis Medical Center, Sacramento, CA, USA.

George R ThompsonDivision of Infectious Diseases, Department of Medicine, University of California Davis, Medical Center, Sacramento, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

We report a case of refractory coccidioidal meningitis presenting with bilateral upper-extremity weakness in a man-in-a-barrel distribution caused by cervical arachnoiditis, adhesive bands, and spinal cord compression. The patient was treated sequentially with fluconazole, other azole therapy, liposomal amphotericin B, intrathecal amphotericin B, and olorofim, with only partial disease control. Neuroimaging demonstrated progressive cervical leptomeningeal inflammation, cord tethering, and CT myelography illustrated adhesive arachnoiditis. Surgical lysis of adhesions and placement of a spinal Ommaya reservoir for intrathecal amphotericin delivery above and below the obstructed segment resulted in partial neurologic improvement. This case broadens the differential diagnosis of man-in-a-barrel syndrome to include active fungal meningitis with compressive cervical myelopathy and highlights the role of combined surgical-medical management in complicated fungal arachnoiditis.

Indexed as

ArachnoiditisCoccidioidal meningitisIntrathecal amphotericinMan-in-a-barrel syndromeSpinal cord compression

Identifiers

PMID42699573

DOI10.1016/j.mmcr.2026.100818

PMCPMC13543813

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