Fungal osteomyelitis with vertebral re-ossification

Area of Science:

• Mycology
• Infectious Diseases
• Spinal Surgery

Background:

• Thoracic vertebral osteomyelitis is a rare spinal infection.
• Pulmonary Blastomyces dermatitides can lead to secondary spinal involvement.
• This case highlights a unique presentation of fungal osteomyelitis.

Purpose of the Study:

• To report a rare case of thoracic vertebral osteomyelitis secondary to Blastomyces dermatitides.
• To describe the diagnostic and management approach.
• To illustrate the potential for conservative treatment in fungal spinal infections.

Main Methods:

• A 27-year-old male with chest pain and cough underwent CT/MR imaging.
• CT-guided biopsy confirmed granulomatous pulmonary Blastomycosis.
• Treatment involved antifungal therapy and TLSO bracing.

Main Results:

• Imaging revealed destructive lytic lesions from T2 to T6 with a soft tissue mass.
• Conservative management resulted in near-resolution of the soft tissue mass.
• Vertebral re-ossification was observed at the affected thoracic levels within 3 months.

Conclusions:

• Fungal osteomyelitis is an uncommon cause of spinal infection.
• Conservative management can be effective, with surgery reserved for instability or neurological compromise.
• Unexpected vertebral re-ossification occurred with antifungal therapy and bracing.