Atypical fungal thoracic vertebral osteomylitis resembling metastatic tumor and literature review of fungal vertebral osteomylitis

Case DescriptionFungal vertebral osteomylitis is a rare disease that difficult to diagnosis and cure. Because the early specific clinical manifestations of this disease are few and atypical, it is often missed or misdiagnosed, resulting in treatment delay and aggravation of the disease.ObjectiveTo report a rare case of cryptococcal osteomyelitis that resembles metastatic tumor happened in an immunecompromised patient with a history of mantle cell lymphoma and to review cases reported in literature.Study DesignBased on imaging studies, metastatic tumor was highly suspected. For a further examination and therapy, the patient was referred to our spine clinic. After admission to our clinical, chest and abdominal CT were checked to evaluate the disease status.TreatmentsAfter general anesthesia, posterior thoracic pedicle screw fixation (T2.3.5.6) were performed, followed by posterior laminectomy and decompression of T4 vertebral body. The right facet joint of T3/4, costal transverse joint, right pedicle and transverse process of T4 vertebra were fully removed and curetted. After careful hemostasis, posterolateral bone grafting was performed. The nail-rod connection is fixed.OutcomesThe postoperative intercostal neuralgia and chest pain were significantly relieved, without complications. The postoperative pathological results were suppurative inflammation with focal granuloma formation, dead bone formation and fungal (cryptococcal) infection. ConclusionsWhen complicated with vertebral fungal spondylitis, no obvious abnormality and fever can be found. When pain or nerve dysfunction caused by spinal cord compression or nerve root compression occurs, surgical treatment can effectively relieve clinical symptoms.