Vertebral osteomyelitis caused by Chaetomium Globosum in a young adult: A case report and literature review

RATIONALE: Chaetomium globosum (C. globosum) is a saprophytic fungus widely distributed in nature, characterized by low clinical pathogenicity but capable of causing severe infections, particularly in immunocompromised hosts or under conducive environmental conditions. Spinal infections attributable to C. globosum are exceedingly rare and often present diagnostic dilemmas due to atypical presentations. This case underscores the importance of considering fungal etiologies in spinal pathologies. Furthermore, the strain mentioned in this study has been appropriately preserved and is available for further research. Researchers interested in investigating the mechanisms underlying its enhanced invasiveness compared to other strains are encouraged to contact the corresponding author. PATIENT CONCERNS: A 24-year-old male was admitted with a chief complaint of persistent low back pain lasting for 2 weeks, without significant relief from initial conservative measures, without immune-related diseases or other comorbidities. DIAGNOSES: Routine fluid analyses showed no indicators of infection; however, magnetic resonance imaging (MRI) demonstrated cystic lesions localized to the L3 vertebra, raising suspicion for a spinal infectious process. Definitive diagnosis was achieved through tissue culture, which identified C. globosum as the causative pathogen. INTERVENTIONS: Initial management employed a dual-therapy approach combining agents aimed at enhancing circulation with conventional analgesics and antiinflammatory drugs. Upon microbiological confirmation, targeted antifungal therapy with itraconazole was initiated. OUTCOMES: The patient exhibited progressive clinical improvement, marked by substantial pain reduction during hospitalization, and attained stable recovery with resolution of symptoms by the time of discharge. LESSONS: This case highlights a rare spinal C. globosum infection in an immunocompetent adult and underscores the importance of considering fungal pathogens in the differential diagnosis of unexplained spinal lesions. Early tissue biopsy with histopathological and molecular analysis is essential for definitive diagnosis and guiding appropriate antifungal therapy.