Cryptococcal spondylodiscitis in a non-HIV patient with CD4 lymphocytopenia

Abstract

Infections that affect the intervertebral discs and vertebrae are known as spondylodiscitis. Such infections are commonly caused by pyogenic organisms, particularly Staphylococcus aureus, and hematogenous spread is the most common route. Non-pyogenic infections include Mycobacterium tuberculosis and Brucellosis. Mycotic infections are becoming more common, in line with the growing number of immunodeficiency disorders. Cryptococcus is included among these mycotic infections. We present a case of such an infection in a nonimmunocompromised patient with a known history of treatment with antitubercular therapy. A 52-year-old man came to our hospital with a backache of one-month duration and progressive neurological deficits of the lower limbs of one-week duration. His imaging studies were suggestive of spondylodiscitis at the D10e11 and D11e12 levels with a left paraspinal abscess. The patient underwent anterolateral decompression, biopsy, and instrumented posterior spinal fusion. The pus grew Cryptococcus, and histopathology confirmed Cryptococcal spondylodiscitis. The patient was treated with parenteral amphotericin B and fluconazole. A mycotic infection must be considered in the differential diagnosis of infectious spondylodiscitis.