Abstract:

Six fungal spondylitis cases initially misdiagnosed as spinal tuberculosis in Kunming Third People’s Hospital from January 2021 to January 2024 were collected, and their clinical data and imaging data were analyzed. It was found that out of the six patients, four cases were male, with a median age of 58 years. Two cases had a history of surgery at the infection site, and one case had combined chronic liver failure. Four cases had positive pus/blood fungal culture or positive pathologic fungal test result; five cases presented pain in the infected spinal segment, and only 1 case presented fever; 2 cases presented elevated peripheral blood leukocyte counts and neutrophil counts, 6 cases had elevated C-reactive protein and erythrocyte sedimentation rate, and 3 cases had positive G test result. Five cases had lumbar spine lesions and 1 case had cervical spine lesions; five cases had single-segment involvement and 1 case had short-segment involvement. Only 3 cases showed bone destruction with X-rays; 6 cases showed lesions in anterior and middle columns of the spine with CT examination, among them, 4 cases had bone destruction centered at the intervertebral discs, and 2 cases centered at the vertebral bodies. In 5 cases, there was no osteosclerotic band around the bone destruction, and MRI showed bone destruction as isotropic T₁WI high T₂WI/T₂WI fat-suppressed signal, while the bone around the bone destruction showed low T₁WI low T₂WI signal/T₂WI fat-suppressed high signal, and in the other one case, there was osteosclerosis around the bone destruction, and MRI showed bone destruction as isotropic T₁WI high T₂WI/T₂WI fat-suppressed signal, while the bone surrounding the bone destruction showed low T₁WI high T₂WI/T₂WI fat-suppressed signal. Six cases all had no compression fracture, posterior convexity deformity, or lumbar masseter abscess on imaging.

Key words: Tuberculosis,spinal, Mycoses, Magnetic resonance imaging, Radiography