陈志源　丁焕文　涂强　沈健坚　刘辉亮　王虹　滕强　贾军锋　庾广文

Objective  To report a case of cryptococcus neoformans osteomyelitis of the sacral vertebrae and to analyze the cause of misdiagnosis. Methods  The clinical data of a patient with cryptococcus neoformans osteomyelitis of the sacral vertebrae who was adopted in 2012 were retrospectively analyzed. Results  Intermittent pain in the sacrum occurred to the patient without any obvious precipitating factors, which became worse at night. And meanwhile, the patient had low-grade fever. Whole body bone scan and single photon emission computed tomography ( SPECT ) / CT showed abnormally active metabolism in the sacrum and bony defects and changes in the right margin. Therefore, bone tumors were considered. Sacral metastases was confirmed using CT-guided needle aspiration biopsy. Debridement was performed after multidisciplinary consultation. The intraoperative frozen pathology presented fungal infections. The postoperative routine pathological examination showed pyogenic and inflammatory granulomas and there were fungal spores in the histocytes. At last, sacral cryptococcus infections was diagnosed. Conclusions  The partial performance of cryptococcus neoformans osteomyelitis of the sacral vertebrae is similar to that of malignant tumors of the sacral vertebrae. So clinical doctors should raise the awareness of the disease. It is necessary to first rule out the possibility of cryptococcus neoformans osteomyelitis of the sacral vertebrae before making the diagnosis of malignant tumors of the sacral vertebrae.