case_images: PMC6744792_01
case_images: Magnetic resonance imaging showing involvement of T4 vertebra with intervertebral disc spaces relatively preserved. (a) T2 weighted, (b) T1 weighted, (c) contrast.
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case_images: PMC6744792_01_SNI-10-81-g001.jpg
case_images: F1
case_images: The magnetic resonance imaging (MRI) demonstrated T4 osteomyelitis with relatively well-preserved intervertebral disc spaces [Figure 1].
case_images: Magnetic resonance imaging showing osteolytic lesions of the fourth thoracic vertebra with cord compression, paravertebral soft tissue mass was seen on both sides of T4 vertebra up to T5-T6 disc space without disc space involvement. (a) T2 weighted, (b) T1 weighted, (c and d) contrast.
case_images: SNI-10-81-g002.jpg
case_images: PMC6744792_01_SNI-10-81-g002.jpg
case_images: F2
case_images: At that point, the MRI demonstrated osteolytic lesions of the T4 vertebral body with cord compression, accompanied by bilateral paraspinal soft tissue masses extending to the T5-T6 level; there was, however, no disc space involvement [Figure 2].
case_images: Postoperative X-rays showing fixation from T2 to T6 level. (a) Immediate postoperative, (b) 3-month follow-up, and (c) 8-month follow-up.
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case_images: PMC6744792_01_SNI-10-81-g003.jpg
case_images: F3
case_images: She underwent a biopsy of the T4 vertebral body, accompanied by transfacet T4 decompression, and posterior T2- T6 pedicle screw instrumentation [Figure 3].
case_images: Histopathological analysis showing inflammatory granulation tissue, focal necrosis with scattered fungal organisms. (a) Periodic acid- Schiff stain, (b) silver stain, (c) mucicarmine stain.
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case_images: PMC6744792_01_SNI-10-81-g004.jpg
case_images: F4
case_images: The culture and histopathological examinations revealed a cryptococcal fungal infection that was sensitive to amphotericin B; this was administered intravenously (150 mg/day) for the next 3 months [Figure 4].
case_images: Three months follow-up magnetic resonance imaging showing prevertebral collection. Compared to preoperative magnetic resonance imaging, there is resolution of the compression over the spinal cord at T4 level. (a) T2 weighted, (b) T1 weighted, (c) short tau inversion recovery.
case_images: SNI-10-81-g005.jpg
case_images: PMC6744792_01_SNI-10-81-g005.jpg
case_images: F5
case_images: Although the MRI still showed some prevertebral collection compared with the preoperative MRI, there was resolution of the T4 cord compression [Figure 5].
case_images: Eight months follow-up magnetic resonance imaging showing complete resolution of prevertebral abscess with resolution of the signal alteration in vertebral bodies. (a) T2 weighted, (b) T1 weighted, (c) short tau inversion recovery.
case_images: SNI-10-81-g006.jpg
case_images: PMC6744792_01_SNI-10-81-g006.jpg
case_images: F6
case_images: In addition, the MRI now showed complete resolution of the prevertebral abscess and the previously abnormal signal within the T3-T5 vertebral bodies [Figure 6].