case_images: PMC10869514_01
case_images: Spine CT/MRI and metagenomic sequencing. A1: moth-eaten changes at L3-L4, affecting discs and endplates. A2-A5: severe spinal canal occupation and potential spondylitis at L3-L4. B1,C1: progressive erosion in L4, L5, L2, and S1 endplates. D1-D4: relieved spinal canal occupation at L3-L4. E1: slow erosion and changes at the inferior endplate of L1. F1,G1: collapse of L1 anterior column and spinal canal mild stenosis. H1: stability and controlled inflammation. K1: Detection of A. flavus.
case_images: fmed-11-1348203-g001.jpg
case_images: PMC10869514_01_fmed-11-1348203-g001.jpg
case_images: fig1
case_images: CRP: 64.15 mg/L). CT imaging showed moth-eaten changes in the L3-L4 vertebral regions, affecting the intervertebral disc and vertebral body endplate (Figure 1A1). MRI investigations suggested severe spinal canal occupation at the L3-L4 segment and potential spondylitis (Figure 1A2-A5), and a biopsy revealed proliferative and degenerative changes without infectious agents. Two weeks post-surgery, CT showed erosion at the L4 and L5 endplates (Figure 1B1). Five weeks post-surgery, a CT scan revealed further damage to the L4 and L5 endplates; meanwhile, similar changes in the L2 and S1 endplates were also observed (Figure 1C1). Further MRI and CT examinations showed a significant improvement in spinal canal occupation at the L3-L4 segment (Figure 1D1-D4). Subsequently, metagenomic next-generation sequencing finally identified A. flavus, with therapy switched to voriconazole (200 mg every 12 h) (Figure 1K1). A lumbar spine CT scan showed slowed progression in the erosion of the most vertebral endplates after 3 months of internal fixation; however, moth-eaten changes began to appear on the inferior endplate of L1 (Figure 1E1). MRI and CT scans indicated mild spinal canal stenosis at the L1-L2 level, with mild collapse of the L1 anterior column (Figure 1F1-F4). However, the anterior column of the L1 vertebral body showed obvious collapse, kyphosis, and spinal instability (Figure 1G1). After 18 months of internal fixation (August 26, 2023), the patient showed basic symptom relief, effective inflammation control (ESR: 12 mm/H, CRP: 7.40 mg/L), good fusion of the L3-L4 bone graft area, and significant glycemic management (Figure 1H1); however, the collapse of the L1 anterior column was still continuing.