Isolated expansile lumbar lesion mimicking malignancy in an immunocompetent individual: Cryptococcosis or blastomycosis
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- DOI: https://doi.org/10.15562/ijn.v5i3.215  |
- Published: 2022-09-02
Background: Cryptococcus is a ubiquitous environmental encapsulated fungus that is widespread in soil, rotten food, and bird droppings. The nervous system and lungs are the most commonly affected sites, while skeletal involvement is seen only in 5 – 10% of all disseminated cases. We present a case of isolated lumbar cryptococcosis (involving the fifth lumbar vertebra) in an immunocompetent individual mimicking malignancy radiologically.
Case presentation: A 43-year-old male school teacher was admitted with low back pain for one month. Lumbar spine magnetic resonance imaging showed an expansive destructive lesion in the right half of the L5 vertebra. The vertebral lesion was destructive with a winking owl eye sign suggesting vertebral metastasis rather than an infectious process. Histopathology examination reported the organism as Blastomyces based on the size and broad-based budding which was later identified correctly as Cryptococcus neoformans var. Grubii by culture and MALDI-TOF mass spectrometry.
Conclusion: This case helped the readers to be aware of unusual causes of isolated vertebral lesions which can mimic metastatic cancer and the importance of fungal culture in identifying the organism correctly.
Keywords: case report; cryptococcosis; expansile lesion; immunocompetent; malignancy