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Abstract：
BACKGROUND Cryptococcosis is an opportunistic fungal infection that typically occurs in patients with compromised immune systems, primarily affecting the respiratory and central nervous systems. However, cryptococcal osteomyelitis is a rare manifestation of cryptococcal infection, characterized by nonspecific clinical features. Here, we present a case of vertebral cryptococcal osteomyelitis in a middle-aged woman and discuss diagnostic approaches. CASE REPORT A 56-year-old woman presented with lower back pain and limited mobility, without fever, and with a history of pulmonary tuberculosis. Physical examination revealed enlarged lymph nodes and tenderness in the thoracic vertebrae. A computed tomography-guided biopsy confirmed granulomatous inflammation caused by Cryptococcus, with abundant 10 μm spherical microbial spores. After 4 weeks of treatment with amphotericin B and fluconazole, symptoms and lesions improved. Upon discharge, the patient was prescribed oral fluconazole. Follow-up examinations showed a stable condition and a negative serum cryptococcal capsular polysaccharide antigen test. CONCLUSIONS Given the rarity and lack of specificity of clinical features of cryptococcal spondylitis, clinicians encountering similar presentations should consider tuberculous spondylitis and spinal tumors as differential diagnoses. Additionally, tissue biopsy of the affected vertebral bodies should be performed early to establish the type of vertebral infection, aiding in diagnosis, treatment, and prognosis.
摘要：
背景技术隐球菌病是一种机会性真菌感染，通常发生在免疫系统受损的患者中。主要影响呼吸和中枢神经系统。然而,隐球菌骨髓炎是隐球菌感染的一种罕见表现，以非特异性临床特征为特征。这里,我们介绍一例中年妇女的椎体隐球菌性骨髓炎，并讨论诊断方法。病例报告一名56岁女性出现下背部疼痛和活动受限，不发烧,有肺结核病史.体格检查发现胸椎淋巴结肿大和压痛。计算机断层扫描引导活检证实由隐球菌引起的肉芽肿性炎症，具有丰富的10μm球形微生物孢子。两性霉素B和氟康唑治疗4周后，症状和病变改善。出院时，患者被处方口服氟康唑。随访检查显示病情稳定，血清隐球菌荚膜多糖抗原试验阴性。结论鉴于隐球菌性脊柱炎的临床特征罕见且缺乏特异性，遇到类似表现的临床医生应将结核性脊柱炎和脊柱肿瘤作为鉴别诊断。此外,应尽早对受影响的椎体进行组织活检，以确定椎体感染的类型，协助诊断,治疗,和预后。
