Article
Rare case of complex fungal spondylitis in the cervical and thoracic spine – case report
Seltener Fall einer Pilz-bedingten Spondylitis in der HWS und BWS – Fallbericht
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Published: | June 4, 2021 |
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Objective: Spondylitis is an infection of the vertebral column, the incidence of which is increasing due to an increase in the susceptile population and improved ascertainment. This disease has been associated with a wide range of microorganisms. Fungal spondylodiscitis is uncommon (0.5-1.6%) and strongly associated with immunosuppression and diabetes. A rare case of fungal spondylitis in a semi-neutropenic patient because of history of lung cancer is reported herein.
Methods: A case of fungal spondylitis of C3-T10 was diagnosed and suspicious in MR imaging. The woman showed history of treated lung cancer by radiation and chemotherapy in 2015 and 2018 and suffered from immobilizing neck and upper back pain (VAS 10). The diagnosis was finally obtained by twice trans-pedicular biopsies of para-vertebral and intra-vertebral contrast enhancements in T6/7. During the course, multiple blood cultures were provided. Scanty samples of Candida species could be verified, especially in a lung cave via CT punction.
Results: Drug therapy consisted of antimycotic medication (Voriconazol) for 12 months, supporting antibiotic therapy for 3 months (amoxicillin, clavulanacid) because of potential bacterial load, and a 3-level analgetic medication for 6 months. A complex orthesis for cervical and thoracic spine lead to substantial posture and pain relief. Regular MR and CT imaging and blood controls were performed (first every 6 weeks, than every 3 months). The patient recovered well, vertebral bone consolidated and so far, no stabilization surgery was necessary.
Conclusion: Diagnosis of fungal spondylitis/spondylodiscitis is rare and often delayed or missed. Physicians should consider this entity in differential diagnosis of vertebral pain especially in immunosuppressed patients, in order to initiate an adequate therapy and to prevent further spinal lesions and disability.