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Review
. 2016 May-Jun;134(3):263-267.
doi: 10.1590/1516-3180.2015.02691801.

Paracoccidioidomycosis in the spine: case report and review of the literature

José Alexandre Lopes da Silva Alvarenga  1 , Délio Eulálio Martins  2 , Michel Kanas  1 , Hugo Gustavo Kunzle Elizeche  3 , Adriana Macêdo Dell'Aquila  4 , Eloy De Avila Fernandes  5 , Marcelo Wajchenberg  6 , Eduardo Barros Puertas  7
Affiliations
Review

Paracoccidioidomycosis in the spine: case report and review of the literature

José Alexandre Lopes da Silva Alvarenga et al. Sao Paulo Med J. 2016 May-Jun.

Abstract
in English, Portuguese

Context:: Paracoccidioidomycosis is a systemic form of mycosis that spreads hematogenously, secondarily to reactivation of lung infection or infection at another site or to new exposure to the causative agent. Few cases of bone involvement have been reported in the literature and involvement of the spine is extremely rare.

Case report:: We describe a case of a 68-year-old male patient with spondylodiscitis at the levels L4-L5 caused by presence of the fungus Paracoccidioides brasiliensis, which was diagnosed through percutaneous biopsy. The patient was treated with sulfamethoxazole and trimethoprim for 36 months, with complete resolution of the symptoms.

Conclusion:: Spondylodiscitis caused by the fungus Paracoccidioides brasiliensis is uncommon. However, in patients with chronic low-back pain who live or used to live in endemic regions, this infection should be considered as a possible differential diagnosis.

CONTEXTO:: Paracoccidioidomicose é uma micose sistêmica de disseminação hematogênica, secundária a reativação de uma infecção pulmonar ou de outro sítio, ou a uma nova exposição ao agente causador. Poucos casos de envolvimento ósseo são relatados na literatura, e o acometimento da coluna vertebral é extremamente raro.

RELATO DE CASO:: Descrevemos o caso de um paciente masculino de 68 anos, apresentando espondilodiscite no nível L4-L5, causada pela presença do fungo Paracoccidioides brasiliensis, diagnosticada após biópsia percutânea. O paciente foi tratado com sulfametoxazol e trimetoprim por 36 semanas, com resolução completa dos sintomas.

CONCLUSÃO:: A espondilodiscite causada pelo fungo Paracoccidioides brasiliensis é incomum, mas, em pacientes portadores de lombalgia crônica que viveram ou vivem em regiões endêmicas, deve ser considerada como um possível diagnóstico diferencial.

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Conflict of interest statement

Conflict of interests: None

Figures

Figure 1:
Figure 1:. Radiography and magnetic resonance imaging (MRI) of lumbosacral spine. (A) Lateral radiograph showing irregular vertebral plates of L4 and L5, and reduction of disc spaces L4-L5 and L5-S1. (B) MRI in sagittal view with T1 fat-saturation contrast, showing spondylodiscitis of L4-L5, with subligamentous inflammatory tissue and reduced disc height of L4-L5 and L5-S1. (C) MRI in axial view with T1 gadolinium contrast, showing inflammatory tissue involving L4 and left psoas muscle.
Figure 2:
Figure 2:. Histological slide of L4, stained with lactophenol cotton blue, showing fungal spores of Paracoccidioides brasiliensis (400 X).
Figure 3:
Figure 3:. Magnetic resonance imaging (MRI) after 36 months of antibiotic therapy showing reduction of paraspinal soft-tissue edema and abscess. (A) Lateral T2 view. (B) Lateral T1 gadolinium view. (C) Axial T1 gadolinium view.
Table 1:
Table 1:. Database search results for Paracoccidioidomycosis and Spine on December 29, 2015
See this image and copyright information in PMC

References

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