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Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases
R L Williams1, M B Fukui, C C Meltzer
1Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA.
Abstract:
The MR imaging findings of fungal spinal osteomyelitis in three recipients of organ transplants showed hypointensity of the vertebral bodies on T1-weighted sequences in all cases. Signal changes and enhancement extended into the posterior elements in two cases. Multiple-level disease was present in two cases (with a total of five intervertebral disks involved in three cases). All cases lacked hyperintensity within the disks on T2-weighted images. In addition, the intranuclear cleft was preserved in four of five affected disks at initial MR imaging. MR features in Candida and Aspergillus spondylitis that are distinct from pyogenic osteomyelitis include absence of disk hyperintensity and preservation of the intranuclear cleft on T2-weighted images. Prompt recognition of these findings may avoid delay in establishing a diagnosis and instituting treatment of opportunistic osteomyelitis in the immunocompromised patient.
Insights
Fungal spinal osteomyelitis in organ transplant recipients shows specific MR imaging features. Key indicators include vertebral body hypointensity and preserved intranuclear clefts, distinguishing it from bacterial infections.
Area of Science:
- Radiology
- Infectious Diseases
- Immunology
Background:
- Fungal spinal osteomyelitis is a rare but serious opportunistic infection in immunocompromised patients, particularly organ transplant recipients.
- Accurate and timely diagnosis is crucial for effective treatment and improved patient outcomes.
- Magnetic Resonance (MR) imaging is a primary modality for evaluating spinal infections.
Observation:
- This study analyzed MR imaging findings in three organ transplant recipients with confirmed fungal spinal osteomyelitis (Candida and Aspergillus species).
- Common findings included vertebral body hypointensity on T1-weighted sequences and signal changes extending to posterior elements.
- Notably, hyperintensity within intervertebral disks on T2-weighted images was absent, and the intranuclear cleft remained preserved in most affected disks.
Findings:
- MR imaging features distinguishing fungal spondylitis from pyogenic osteomyelitis were identified.
- Absence of disk hyperintensity and preservation of the intranuclear cleft on T2-weighted images are key differentiating characteristics.
- These findings were consistently observed across the studied cases of fungal spinal infection.
Implications:
- Prompt recognition of these distinct MR imaging features can expedite the diagnosis of opportunistic fungal osteomyelitis.
- Early diagnosis facilitates timely initiation of appropriate antifungal therapy in immunocompromised patients.
- This research aids radiologists and clinicians in differentiating fungal from bacterial spinal infections, optimizing patient management.