Zhou Yunlong, Liu Zhiqiang, Yu Hui, Guo Guiying, Yang Xing, Zhang Junyu
Department of Orthopedics, Leshan People's Hospital, No. 238 Baita Street, Shizhong District, Leshan, Sichuan Province, China.
BMC Infect Dis. 2024 Dec 18;24(1):1427. doi: 10.1186/s12879-024-10307-1.
Fungal spondylitis often occurs in patients with immune dysfunction, and its diagnosis and treatment pose certain challenges. However, even in immunocompromised patients, Aspergillus spondylitis remains rare. This case reports the diagnostic and therapeutic experience of fungal spondylitis in a patient with consolidated cirrhosis and no significant immune impairment.
A 45-year-old agricultural worker had chest and back pain for 6 months. The patient's pain was a persistent dull ache that worsened with chronic coughing and postural changes and decreased when he was laying down. Based on the patient's clinical presentation, biochemical tests and imaging, considered possible spinal tuberculosis. Empirical anti-tuberculosis treatment was not successful. Due to the failure of medication and the formation of an epidural abscess, the decision was made to proceed with surgical treatment. Intraoperative tissue specimens were subjected to high throughput testing for culture, tuberculosis gene X-pert and high-throughput detection of macro-gene infectious agents. It was confirmed that the spinal infection was caused by Aspergillus fumigatus. Tuberculosis medication was ceased and antifungal therapy with voriconazole was started. Three months after surgery, the patient recovered well with no fever or pain.
In summary, in addition to patients with low immune function who should be evaluated for fungal spondylitis, patients with infectious diseases of the spine who are immunocompetent but have comorbid cirrhosis should be evaluated when treatment fails. If the diagnosis cannot be made by conventional or unconventional methods, surgical methods should be used in a timely manner for diagnosis and treatment.
真菌性脊柱炎常发生于免疫功能障碍患者，其诊断和治疗具有一定挑战性。然而，即使在免疫功能低下的患者中，曲霉菌性脊柱炎仍然罕见。本病例报告了一名合并肝硬化且无明显免疫功能损害患者的真菌性脊柱炎诊断及治疗经验。
一名45岁的农业工人胸部和背部疼痛6个月。患者的疼痛为持续性隐痛，慢性咳嗽和体位改变时加重，躺下时减轻。根据患者临床表现、生化检查及影像学检查，考虑可能为脊柱结核。经验性抗结核治疗未成功。由于药物治疗失败及硬膜外脓肿形成，决定进行手术治疗。术中组织标本进行高通量培养检测、结核基因Xpert检测及宏基因感染因子高通量检测。确诊脊柱感染由烟曲霉引起。停用抗结核药物，开始伏立康唑抗真菌治疗。术后3个月，患者恢复良好，无发热及疼痛。
综上所述，除对免疫功能低下患者应评估是否为真菌性脊柱炎外，对于免疫功能正常但合并肝硬化的脊柱感染患者，治疗失败时也应进行评估。若常规或非常规方法无法确诊，应及时采用手术方法进行诊断和治疗。
