脊柱白念珠菌感染1例并文献复习

Spinal Candida albicans infection:A case report and literature review

患者,男,32岁,因“检查发现双侧肋软骨及脊柱多发骨破坏4个月”入院。患者4个月前因回肠造瘘术后,拟行回肠还纳入住我院肿瘤外科,完善检查发现双侧肋软骨及脊柱多发骨破坏,行超声引导下肋软骨穿刺活检术,病理考虑慢性化脓性炎,未行治疗。入院1个月前复查骨破坏范围增大,再次行超声引导下肋软骨穿刺活检术,术后送结核分枝杆菌DNA检测,结果为阴性。此次因腰痛症状逐渐加重入院,体检腰、骶椎中线及椎旁压痛,腰椎屈伸活动受限,双下肢运动、感觉及反射正常。完善常规检查后行CT引导下腰椎穿刺活检及培养,明确诊断为白念珠菌感染。采用氟康唑静滴,3周后改为口服药物治疗,8周后复查腰痛症状明显改善,MRI示:椎体上下缘骨侵蚀及椎间盘破坏减轻。病情较前明显好转,随访中。

A 32-year-old male patient was admitted to the hospital because of‘examination revealed costochondral joints and spinal multiple bone destruction for four months’.Four months ago,the patient was admitted to the oncology department of our hospital for ileostomy surgery with ileum restoration.After thorough examination,it was found thatcostochondral joints and spinal multiple bone destruction,and ultrasound guided needle biopsy of costochondral joints was performed.The pathological consideration was chronic suppurative infection,but no treatment was performed.One month before admission,the range of costochondral joints and spinal bone damage increased during reexamination.Ultrasound guided needle biopsy of costochondral joints was performed again,Mycobacterium tuberculosis DNA testing was sent,and the result was negative.After surgery,DNA test results for Mycobacterium tuberculosis were negative.This time,the symptoms of low back pain gradually worsened,physical examination of lumbar,sacral midline and paravertebral tenderness,lumbar flexion and extension activities were limited,and the movement,sensation and reflexes of both lower limbs were normal.CT-guided lumbar needle biopsy were completed to confirm the diagnosis of Candida albicans infection.Fluconazole intravenous drip for three weeks,and then changed to oral drug treatment.After 8 weeks,there was a significant improvement in the symptoms of lower back pain upon reexamination.Magnetic resonance imaging showed a reduction in vertebral bone and intervertebral disc destruction.The condition improved significantly and was under follow-up.