误诊为脊柱结核的真菌性脊柱炎临床及影像特征分析

Clinical and imaging characterization of fungal spondylitis misdiagnosed as spinal tuberculosis

收集昆明市第三人民医院2021年1月至2024年1月收治的6例初诊误诊为脊柱结核的真菌性脊柱炎患者,对患者临床资料及影像学资料进行分析。结果发现,6例患者中,4例为男性,中位年龄58岁,2例既往有感染部位的手术史,1例并发慢性肝衰竭;4例脓液/血液培养或病理学真菌阳性;5例表现为感染脊柱节段疼痛,仅1例表现为发热;2例出现外周血白细胞总数及中性粒细胞计数升高,6例C反应蛋白及血红细胞沉降率升高,3例G试验阳性;5例为腰椎病变,1例为颈椎病变;5例为单节段受累,1例为短节段受累;X线检查仅3例表现为骨质破坏;CT检查6例累及脊柱的前柱及中柱,4例骨质破坏以椎间盘为中心,2例骨质破坏以椎体为中心;5例骨质破坏周围无骨质硬化带,在MRI上骨质破坏表现为等T_(1)WI高T_(2)WI/T_(2)WI脂肪抑制信号,而骨质破坏周围骨质表现为低T_(1)WI低T_(2)WI,T_(2)WI脂肪抑制呈高信号,1例骨质破坏周围出现骨质硬化,在MRI骨质破坏表现为等T_(1)WI高T_(2)WI/T_(2)WI脂肪抑制信号,而骨质破坏周围骨质表现为低T_(1)WI高T_(2)WI/T_(2)WI脂肪抑制信号,6例均未出现压缩性骨折、后凸畸形、腰大肌脓肿的影像学表现。

Six fungal spondylitis cases initially misdiagnosed as spinal tuberculosis in Kunming Third People’s Hospital from January 2021 to January 2024 were collected,and their clinical data and imaging data were analyzed.It was found that out of the six patients,four cases were male,with a median age of 58 years.Two cases had a history of surgery at the infection site,and one case had combined chronic liver failure.Four cases had positive pus/blood fungal culture or positive pathologic fungal test result;five cases presented pain in the infected spinal segment,and only 1 case presented fever;2 cases presented elevated peripheral blood leukocyte counts and neutrophil counts,6 cases had elevated C-reactive protein and erythrocyte sedimentation rate,and 3 cases had positive G test result.Five cases had lumbar spine lesions and 1 case had cervical spine lesions;five cases had single-segment involvement and 1 case had short-segment involvement.Only 3 cases showed bone destruction with X-rays;6 cases showed lesions in anterior and middle columns of the spine with CT examination,among them,4 cases had bone destruction centered at the intervertebral discs,and 2 cases centered at the vertebral bodies.In 5 cases,there was no osteosclerotic band around the bone destruction,and MRI showed bone destruction as isotropic T_(1)WI high T_(2)WI/T_(2)WI fat-suppressed signal,while the bone around the bone destruction showed low T_(1)WI low T_(2)WI signal/T_(2)WI fat-suppressed high signal,and in the other one case,there was osteosclerosis around the bone destruction,and MRI showed bone destruction as isotropic T_(1)WI high T_(2)WI/T_(2)WI fat-suppressed signal,while the bone surrounding the bone destruction showed low T_(1)WI high T_(2)WI/T_(2)WI fat-suppressed signal.Six cases all had no compression fracture,posterior convexity deformity,or lumbar masseter abscess on imaging.