Age / Sex : 74 / M

Candida spondylitis

Discussion

Findings:

Multifocal endplate bone erosions with multilobulated paravertebral abscess formation at T12-L2 on CT and MR scans

Differential Diagnosis:

Bacterial spondylitis:

-       Early intervertebral disc and bone destruction

-       Reactive bone changes with sclerosis

Tuberculous spondylitis:

-       subligamentous spread of infection to three or more vertebral bodies and involvement of multiple vertebral bodies,

-       relative preservation of the intervertebral disc,

-       presence of skipped lesion.

Diagnosis:  

Candida spondylitis

Discussion:

Fungal spondylitis occurs primarily as an opportunistic infection, and Candida and Aspergillus species are the most common causative fungal organisms. Candida spondylitis should be considered when the infectious lesions involve contiguous vertebrae without intervertebral disk destruction with paraspinal inflammatory mass of unusually low signal intensity, and paraspinal abscess, when present, is small. Low signal intensity on T2WI may be due to chronic inflammation and fibrosis caused by low virulence pathogen. Paramagnetic substances such as melain synthesized in some species of fungus or underlying degenerative osteophytosis may contribute to the low signal intensity on T2WI. A clinical history of chronic illness would be helpful during the differential diagnosis.

References:

 Candida Spondylitis: Comparison of MRI Findings With Bacterial and Tuberculous Causes. AJR 2013; 201:872–877