Yang Hong, Wang Xin, Zhu Weijian, Zhou Bei
Department of Spine Surgery, Wuhan Fourth Hospital, Wuhan, China.
Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2025 Jan 8;11:1499153. doi: 10.3389/fmed.2024.1499153. eCollection 2024.
Tropical Candida spondylitis is an uncommon cause of lower back pain in patients, especially in non-tropical areas or in patients not at risk of immunocompromise.
A 65-year-old woman presented with a six-month history of poorly managed low back pain, now accompanied by numbness and pain in both lower extremities. Her medical history was significant for tertiary hypertension. Inflammatory markers were mildly elevated. MRI fluid sequences revealed lamellar enhancement of the L4-5 vertebral bodies, narrowing of the intervertebral space, peripheral soft tissue edema, and spinal canal compression. After 3 weeks of empirical anti-tuberculosis therapy, the patient's symptoms did not improve, prompting posterior lesion debridement and autologous iliac bone grafting with pedicle screw fixation. Postoperatively, disc tissue cultures and next-generation sequencing (NGS) identified . The patient was subsequently treated with a six-week course of voriconazole, resulting in symptomatic improvement, with no recurrence observed during follow-up.
The imaging and clinical presentation of spondylitis can closely mimic that of tuberculous spondylitis, particularly in patients without clear risk factors for immune compromise. This overlap in presentation often complicates the differential diagnosis, leading to potential delays in appropriate treatment.
热带念珠菌性脊柱炎是患者下背部疼痛的罕见原因，尤其是在非热带地区或无免疫功能低下风险的患者中。
一名65岁女性，有6个月管理不善的下背部疼痛病史，现伴有双下肢麻木和疼痛。她有三级高血压病史。炎症标志物轻度升高。MRI液体序列显示L4-5椎体层状强化、椎间隙变窄、周围软组织水肿和椎管受压。经验性抗结核治疗3周后，患者症状未改善，遂行后路病灶清除、自体髂骨植骨及椎弓根螺钉固定术。术后，椎间盘组织培养和下一代测序（NGS）鉴定出……。患者随后接受了为期六周的伏立康唑治疗，症状改善，随访期间未观察到复发。
念珠菌性脊柱炎的影像学表现和临床表现可与结核性脊柱炎极为相似，尤其是在无明确免疫功能低下危险因素的患者中。这种表现上的重叠常常使鉴别诊断复杂化，导致适当治疗可能延迟。
