脊柱感染对于诊断和治疗提出了挑战，需要脊柱外科医生、放射科医生和传染病专家的多学科合作。感染通常由细菌微生物引起，但也可能发生真菌感染。早期诊断为脊柱感染的大多数患者可以通过保守治疗，包括使用抗生素、卧床休息和脊柱支具来成功管理。在明显或濒临不稳定性、进行性神经功能障碍、保守治疗失败、脊柱脓肿形成、严重症状指示败血症以及先前保守治疗失败的情况下，需要进行手术治疗。 一名64岁男性患者前往门诊部述说双上肢疼痛已有4个月之久。疼痛为射击性，放射至双侧臂部、前臂和手部，并无加重和缓解因素。他有声门底窝癌的已知病史，曾接受多次化疗。十年后，他因喉水肿接受了气管切开术，并因喂养困难而再次行食管镜胃造瘘术。随后，他出现了发热和颈部疼痛，以及双上肢疼痛。怀疑是感染病因，因此开始多种抗生素治疗，但未见积极反应。进行了磁共振成像（MRI）检查，提示椎间盘脊柱炎可能是结核病起因。进行了活检以确认诊断，随后开始进行抗结核治疗（HRZE）。他还接受了多劳西嗪和加巴喷丁治疗，病情略有改善。随后的MRI显示多个颈椎椎体广泛受累并伴有脊髓压迫。先后进行了两个阶段的前方椎体切除术和后方内固定术。手术后，患者出现感染，通过抗生素治疗管理。钛合金植入物未被移除。计划利用胸肌完成肌肉移植并进行瓣膜闭合手术。组织还被送去进行革兰氏染色、酸快杆菌染色和基因扩增实验（GeneXpert），结果显示正常。最后，在组织培养中分离出假丝酵母。通过酶免疫测定试验，发现为曲霉菌（半乳甘露聚糖抗原）阳性。抗结核治疗停止。随后，他接受抗真菌药物口服伏立康唑治疗1年半。 与真菌性脊柱椎间盘炎诊断的患者通常有良好的预后，可能与及时发现、彻底手术清创和适当使用唑类药物有关。我们的案例通过及时发现并通过组织培养进行确认，检测脊髓压迫并进行减压，并开始特异性抗真菌治疗，取得了成功。延迟开始抗真菌治疗与预后较差，特别是在神经健康方面。我们的患者接受了1年完整的伏立康唑治疗，表明对真菌性脊柱椎间盘炎通过迅速适当的手术和抗真菌药物治疗可以获得良好的预后。 总结起来，在免疫受损患者的所有不明脊柱感染病例中，评估真菌感染是必要的，不论其表现如何。如果抗真菌治疗无效，通常采用手术方法治疗真菌性脊柱椎间盘炎。我们的报告详细描述了一例通过手术方法治疗的真菌性脊柱椎间盘炎成功案例，并强调了真菌感染可能是非压迫性脊髓病的病因之一，有时可能被误认为是放射性脊髓炎。 版权所有 © 2023 作者。由 Wolters Kluwer Health, Inc. 发布。

Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. Most patients with spinal infections diagnosed in the early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces. In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment, surgical treatment is required.A 64-year-old male presented to the Outpatient Department with a complaint of pain in bilateral upper extremities for 4 months. The pain was shooting in type, radiating to bilateral arms, forearms, and hands with no aggravating and relieving factors. He is a known case of carcinoma pyriform sinus for which he underwent various cycles of chemotherapy. Ten years later, a tracheostomy was performed for laryngeal edema, and again, an endoscopic gastrostomy was performed due to feeding difficulties. He then developed fever and cervical pain along with pain in the bilateral upper extremities. An infectious etiology was suspected for which multiple antibiotics were started with no positive response. An MRI was performed, which was suggestive of spondylodiscitis probably of tubercular origin. A biopsy was done to confirm the diagnosis, following which antitubercular (HRZE) therapy was started. He was also treated with Duloxetine and gabapentin, which resulted in minor improvements. Subsequent MRIs showed diffuse involvement of the multiple cervical vertebrae along with cord compression. Two stages of anterior corpectomy followed by posterior instrumentation were done. Following the procedure, the patient developed an infection, which was managed with antibiotics. The titanium implant was not removed. A muscle graft was planned with the pectoralis muscle and flap closure was done. The tissue was also sent for Gram stain, AFB stain, and GeneXpert, which showed normal findings. Finally, in tissue culture, Candida albicans was isolated. On performing the enzyme immunoassay test, it was found to be Aspergillus (Galactomannan antigen) positive as well. Antitubercular treatment was stopped. Then, he was managed with an antifungal, oral voriconazole, for the duration of 1 and a half years.Patients diagnosed with Candida spondylodiscitis tend to have favorable outcomes, likely linked to timely identification, thorough surgical debridement, and proper azole medication. Our case achieved success by promptly identifying and confirming it through tissue culture, detecting spinal cord compression, decompressing it, and initiating specific antifungal treatment. A delay in commencing antifungal therapy has been associated with poorer outcomes, especially in neurological health. Our patient received voriconazole for a full year, suggesting that favorable outcomes are achievable for fungal spondylodiscitis with swift and appropriate surgery and antifungal medication.In summary, evaluation for fungal infection is essential in all cases of unexplained spinal infection in immunocompromised patients, regardless of presentation. If the antifungal treatment proves ineffective, a surgical approach is typically employed for the management of fungal spondylodiscitis. Our report details a successful case of fungal spondylodiscitis treated with a surgical approach and highlights the potential for a fungal infection to be a causative factor in noncompressive myelopathy, which may be sometimes mistaken for radiation myelitis.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.