Spinal Cryptococcosis Mimicking Tuberculous Spondylitis

Cryptococcus neoformans , an opportunistic fungal pathogen, predominantly affects immunocompromised individuals, such as those with HIV/AIDS or on long-term corticosteroid therapy. A 50-year-old Indian male with longstanding diabetes mellitus presented with persistent left scapular pain. Initial management with antitubercular therapy, based on a paravertebral cold abscess and granulomatous inflammation, led to worsening pain, bilateral lower limb weakness, and tingling extending to the toes. Computed tomography (CT) revealed lytic lesions involving the D1 and D2 vertebrae, ribs, and a prevertebral soft tissue mass causing spinal cord compression at T1–T2. Histopathology following corpectomy and spinal fusion confirmed C. neoformans through culture. Following surgical intervention, transition to antifungal therapy with oral fluconazole resulted in lesion resolution, significant pain reduction, and complete resolution of neurological symptoms within 12 weeks.