Lumbar Spine Mucormycosis Mimicking Pott's Spine: A Case Report

Spinal mucormycosis is an exceptionally rare form of invasive fungal infection, with fewer than 12 confirmed cases reported in the prior literature. Immunocompromised patients are disproportionately affected, and mortality exceeds 50% in this population. Chronic liver disease as a primary predisposing condition is underrepresented in the existing case series.

A 54-year-old male with Child-Pugh Grade C chronic liver cirrhosis, diabetes mellitus, and hypothyroidism presented with progressive low back pain and bilateral lower limb weakness of one week duration. Lumbar MRI demonstrated L2-L3 spondylodiscitis with epidural abscess formation, initially attributed to Pott's spine, and antitubercular therapy (ATT) was initiated empirically. Rapid neurological deterioration prompted surgical re-evaluation. The patient underwent an L3 laminectomy with drainage of an L3-L4 anterior epidural abscess. Intraoperative microscopy revealed aseptate ribbon-like hyphae consistent with Mucorales species. Liposomal Amphotericin B (5 mg/kg/day), intravenous micafungin, and oral posaconazole were commenced. Antifungal therapy was complicated by progressive nephrotoxicity and hepatic decompensation requiring repeated dose modifications. The patient developed hepatic encephalopathy with sepsis and died on Postoperative day (POD) 12 from multiorgan failure.

This case represents the 12th documented instance of spinal mucormycosis and the first attributable to Child-Pugh Grade C liver disease. In tuberculosis-endemic settings, mucormycosis must be considered in the differential diagnosis of apparent Pott's spine in immunocompromised patients, particularly those with progressive neurological deterioration despite empirical ATT. Concurrent hepatic and renal impairment substantially constrains antifungal options and worsens prognosis. Multidisciplinary coordination and early tissue diagnosis are critical to the management of this rare, life-threatening condition.