Presentation
Back pain.
Patient Data
Selected sagittal images from an MRI demonstrate features of discitis and osteomyelitis of L2/3 are present with fluid within the disc and erosion of the endplates. Prominent enhancement and paravertebral stranding. No epidural collection of cauda equina compression.
Case Discussion
The patient went on to have surgery.
Histology
Sections show the specimen to consist of pieces of cartilage, including cartilage end-plate, lamellar bone, paravertebral soft tissue including skeletal muscle, adipose tissue, and a portion of peripheral nerve. Acute, subacute and chronic inflammation is observed. Granulation tissue is evident. Degenerative and reactive changes are also seen. The methenamine silver stained sections confirm the presence of fungal microorganisms that display yeast-like forms with focal budding. Hyphae are also seen. The appearance is consistent with Candida. Some cystic structures contain small Gram-negative structures that could represent degenerative bacteria, or degenerate material showing calcification. Microorganisms are not identified in the ZN-stained sections. There is no evidence of metastatic carcinoma in this material.
Final diagnosis: fungal microorganisms identified, consistent with Candida.
Discussion
In this instance, chronic discitis osteomyelitis was due to infection with Candida albicans. This is far less common than bacterial discitis.