Vertebral cryptococcosis simulating tuberculosis.
Infection with the fungus Cryptococcus neoformans is seen predominantly in two forms: (a) pulmonary and (b) cerebromeningeal. Skeletal cryptococcosis is uncommon. There have been only occasional case reports of thoracic vertebral cryptococcosis presenting as cord compression. A young female had cervical lymphadenopathy diagnosed as tuberculosis by fine needle aspiration cytology (FNAC) and was on antitubercular therapy (ATT) for 5 months. She developed rapidly progressive paraparesis and imaging demonstrated a destructive vertebral body lesion involving T2-3 with a paraspinal abscess producing cord compression. A costotransversectomy with excision of the diseased bone and bone grafting was done. Histopathological examination revealed cryptococcosis. The patient was put on antifungal medication, but expired 2 weeks after surgery. Radiological, magnetic resonance imaging and surgical finding of vertebral cryptococcosis can mimic tuberculosis. The definite diagnosis of cryptococcosis depends upon microscopic identification of the organism. A high index of suspicion leading to early surgical confirmation and institution of anti fungal therapy is necessary to reduce the mortality and morbidity.
Gupta
S K
SK
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Chhabra
R
R
Sharma
B S
BS
Das
A
A
Khosla
V K
VK
D000328:Adult; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D013117:Spinal Cord Compression / Q000382:microbiology; D013122:Spinal Diseases / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000473:pathology*; D014399:Tuberculosis, Spinal / Q000175:diagnosis