title: Paracoccidioidomycosis in the spine: case report and review of the literature.
abstract: 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.
  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.
  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.
authors.affiliation: MD. Spine Resident, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: José Alexandre Lopes da Silva
authors.initials: JA
authors.lastname: Alvarenga
authors.affiliation: MD, PhD. Attending Physician, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Délio Eulálio
authors.initials: DE
authors.lastname: Martins
authors.affiliation: MD. Spine Resident, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Michel
authors.initials: M
authors.lastname: Kanas
authors.affiliation: MD. Spine Fellow, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Hugo Gustavo Kunzle
authors.initials: HG
authors.lastname: Elizeche
authors.affiliation: MD, PhD. Infectious Disease Specialist, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Adriana Macêdo
authors.initials: AM
authors.lastname: Dell'Aquila
authors.affiliation: MD, PhD. Affiliated Professor, Department of Imaging Diagnostics, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Eloy De Avila
authors.initials: EA
authors.lastname: Fernandes
authors.affiliation: MD, PhD. Affiliated Professor, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Wajchenberg
authors.affiliation: MD, PhD. Full Professor, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
authors.forename: Eduardo Barros
authors.initials: EB
authors.lastname: Puertas
mesh_terms: D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D010228:Paracoccidioides / Q000302:isolation & purification; D010229:Paracoccidioidomycosis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology