title: Cryptococcosis of lumbar vertebra in a patient with rheumatoid arthritis and scleroderma: case report and literature review.
abstract: BACKGROUND
  Although cryptococcosis mainly occurs in the central nervous system and lungs in immunocompromised hosts, it can involve any body site or structure. Here we report the first case of primary cryptococcosis of a lumbar vertebra without involvement of the central nervous system or lungs in a relatively immunocompromised individual with rheumatoid arthritis and scleroderma.
  
  
  METHODS
  A 40-year-old Chinese woman with rheumatoid arthritis diagnosed 1 year beforehand and with a subsequent diagnosis of scleroderma was found to have an isolated cryptococcal infection of the fourth lumbar vertebra. Her main complaints were severe low back and left leg pain. Cryptococcosis was diagnosed by CT-guided needle biopsy and microbiological confirmation; however, serum cryptococcal antigen titer was negative. After 3 months of antifungal therapy with fluconazole the patient developed symptoms and signs of scleroderma, which was confirmed on laboratory tests. After taking fluconazole for 6 months, the progressive destruction of the lumbar vertebral body had halted and the size of an adjacent paravertebral mass had decreased substantially. On discharge symptoms had resolved and at an annual follow-up there was no evidence of recurrence on the basis of symptoms, signs or imaging investigations.
  
  
  CONCLUSIONS
  Although cryptococcosis of the lumbar vertebra is extremely rare, it should be considered in the differential diagnosis for patients with lumbar vertebral masses to avoid missed diagnosis, misdiagnosis and diagnostic delay. Early treatment with antifungals proved to be a satisfactory alternative to surgery in this relatively immunocompromised patient. Any residual spinal instability can be treated later, once the infection has resolved.
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, 300052, PR China.
authors.forename: Heng-Xing
authors.initials: HX
authors.lastname: Zhou
authors.forename: Guang-Zhi
authors.initials: GZ
authors.lastname: Ning
authors.forename: Shi-Qing
authors.initials: SQ
authors.lastname: Feng
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Jia
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Hong-Yong
authors.initials: HY
authors.lastname: Feng
authors.forename: Wen-Dong
authors.initials: WD
authors.lastname: Ruan
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000382:microbiology* / Q000473:pathology; D001850:Bone Diseases, Infectious / Q000382:microbiology* / Q000473:pathology; D003453:Cryptococcosis / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D012595:Scleroderma, Systemic / Q000382:microbiology* / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed