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免疫功能正常患者椎间盘周围环形高信号的脊柱炎:一例报告及文献复习

spondylitis in an immunocompetent patient with annular high signal around the intervertebral disks: a case report and literature review.

作者信息

Xu Zhihao, Zhu Weijian, Zhou Sirui, Zhao Yuting, Xiang Qi, Zhang Yi

机构信息

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.

Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Med (Lausanne). 2025 Jan 13;11:1532282. doi: 10.3389/fmed.2024.1532282. eCollection 2024.

Abstract

spondylitis is a rare fungal infection, primarily occurring in immunocompromised patients, although cases in immunocompetent individuals have also been reported. While is commonly associated with pulmonary infections, it can also cause spondylitis. Patients typically present with back pain, limb numbness, and neurological compression symptoms. Imaging findings often show vertebral destruction, reduced disk height, and paraspinal abscesses, potentially accompanied by characteristic ring-enhancing lesions. MRI findings can help distinguish spondylitis from other conditions such as tuberculous spondylitis. This case involves an immunocompetent patient with spondylitis, whose non-specific clinical manifestations can easily be confused with other types of spinal infections, leading to a potential misdiagnosis. Diagnosis requires tissue biopsy and microbiological culture. Voriconazole is the first-line antifungal agent, and studies have shown that it improves patient response and survival rates. For patients with significant spinal compression or neurological symptoms, surgical intervention combined with antifungal treatment should be considered if antifungal therapy alone is ineffective. Although spondylitis is rare, it can occur in immunocompetent individuals. Early diagnosis through imaging and biopsy is crucial, and a combination of surgery and antifungal therapy can help improve prognosis.

摘要

曲霉性脊柱炎是一种罕见的真菌感染,主要发生在免疫功能低下的患者中,不过免疫功能正常个体的病例也有报道。虽然曲霉通常与肺部感染有关,但它也可导致脊柱炎。患者通常表现为背痛、肢体麻木和神经受压症状。影像学检查结果常显示椎体破坏、椎间盘高度降低和椎旁脓肿,可能伴有特征性的环形强化病变。磁共振成像(MRI)结果有助于将曲霉性脊柱炎与其他疾病如结核性脊柱炎区分开来。本病例涉及一名患有曲霉性脊柱炎的免疫功能正常患者,其非特异性临床表现很容易与其他类型的脊柱感染相混淆,从而导致潜在的误诊。诊断需要组织活检和微生物培养。伏立康唑是一线抗真菌药物,研究表明它可改善患者的反应和生存率。对于有明显脊柱受压或神经症状的患者,如果单纯抗真菌治疗无效,应考虑手术干预联合抗真菌治疗。尽管曲霉性脊柱炎罕见,但它可发生在免疫功能正常的个体中。通过影像学和活检进行早期诊断至关重要,手术和抗真菌治疗相结合有助于改善预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/88a8/11771204/590716939383/fmed-11-1532282-g001.jpg

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