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Melampsora spondylitis presenting with unexplained low back pain: A case report
Weijian Zhu1, Sirui Zhou2, Zhihao Xu3
1Department of Orthopedics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Background:
Spondylitis is a spinal infection which has been increasing in susceptible populations globally. This disease is caused by various microorganisms. Fungal spondylitis is rare in clinical practice and is strongly associated with immunosuppression and diabetes. Here, we report a case of suspected ca Melampsora spondylitis.
Case Presentation:
A patient was suspected with Melampsora spondylitis at the L3-S1 level. The patient received two surgical operations and antifungal treatments. The next-generation sequencing (NGS) analysis of the tissue specimen obtained during the two surgical procedures confirmed the diagnosis of Melampsora spondylitis. The patient was successfully treated with voriconazole, vancomycin, and meropenem following surgical debridement with pedicle screw internal fixation.
Conclusion:
The diagnosis of fungal spondylitis is often delayed or missed. Physicians should consider fungal spondylitis in the differential diagnosis of neck pain to facilitate early treatment and prevent spinal cord injury and disability. Although fungal infections often occur in immunocompromised patients, fungal spondylitis has also been reported in immunocompetent patients in recent years. In addition, Candida albicans is usually considered a common bacterium in fungal spondylitis. This case underscores the need to develop more advanced diagnostic and therapeutic techniques to identify the pathogenic bacteria associated with fungal spondylitis besides Candida albicans.
Insights
Fungal spondylitis, a rare spinal infection, is increasingly reported. Early diagnosis and advanced treatments are crucial for managing this condition, especially in non-immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Mycology
- Spinal Surgery
Background:
- Spondylitis, a spinal infection, is rising globally, with fungal causes being rare but serious.
- Fungal spondylitis is often linked to immunosuppression and diabetes, but can occur in immunocompetent individuals.
- Delayed diagnosis of fungal spondylitis can lead to severe neurological deficits and disability.
Observation:
- A case of suspected fungal spondylitis at the L3-S1 spinal level is presented.
- Next-generation sequencing (NGS) confirmed the diagnosis of Melampsora spondylitis.
- The patient underwent surgical debridement with internal fixation and received antifungal and antibiotic treatment.
Findings:
- Successful treatment of Melampsora spondylitis was achieved with voriconazole, vancomycin, and meropenem.
- This case highlights the importance of considering fungal pathogens beyond Candida albicans in spondylitis.
- The diagnosis of fungal spondylitis was confirmed via NGS analysis of surgical specimens.
Implications:
- Physicians should include fungal spondylitis in the differential diagnosis for spinal infections, even in immunocompetent patients.
- Advanced diagnostic tools like NGS are vital for identifying rare fungal pathogens causing spondylitis.
- Developing novel therapeutic strategies is essential for improving outcomes in fungal spondylitis.
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