Case Report A Rare Case of Pheohyphomycotic Lumbar Spondylodiscitis Mistreated as Koch’s Spine Shakti A. Goel, 1 Hitesh N. Modi, 1 Yatin J. Desai, 1 and Harshal P. Thaker 2 1 Department of Orthopaedics and Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Taltej, Ahmedabad, Gujarat, India 2 Dr. Harshal Taker’s Clinic, Ambawadi, Ahmedabad, Gujarat, India Correspondence should be addressed to Hitesh N. Modi; modispine@yahoo.co.in Received 7 November 2016; Revised 17 November 2016; Accepted 29 November 2016 Academic Editor: Mark K. Lyons Copyright © 2016 Shakti A. Goel et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pheohyphomycosis is an uncommon infection and its association in spondylodiscitis has not yet been reported. Te purpose of this case report is to describe a rare case of Pheohyphomycotic spondylodiscitis and methods to diagnose and manage the patient with less invasive techniques. A 29-year-old male patient presented to the outpatient department with complaints of gradually increasing low back pain with bilateral lower limbs radicular pain since one and a half years. He had associated fever, weight loss, voice changes, and dry, scaly, erythematous skin with elevated ESR. Te patient had been taking anti-Koch’s therapy since 1 year with little relief in pain and no radiological improvement. Percutaneous pedicle biopsy of L4 vertebra was taken under local anaesthesia and confrmed Pheohyphomycosis which was treated with antifungal medications. Te patient showed sequential improvement with long term antifungal treatment. He was eventually able to walk independently without support. 1. Introduction Pheohyphomycosis represents infections caused by pig- mented flamentous fungi which contain melanin in their cell walls [1]. Teir morphologic characteristics include hyphae, yeast-like cells, or combination [2]. Tey are either associated with Alternaria or Exophiala jeanselmei [3, 4]. Pheohyphomycosis is an uncommon infection and al- most all reported cases have occurred in immunosuppressed patients with 80 percent mortality rate [5]. Te disease is transmissible through air, wind, and water. Te contacted individuals and population can be easily afected by it and usually it is too late to be successfully treated by the time the disease is recognized. Whenever seen, these organisms afect the skin and subcutaneous tissue with nodules or cyst [6]. Eye infections and plaques and granulomatous damage on the body have also been reported [7]. However, efect on spine by this organism in Southern Asia has not yet been seen. Here we report a unique case of Pheohyphomycosis of lumbosacral spine, previously mistaken for Koch’s spine (TB) and treated accordingly. Te patient did not report any improvement for a long time until the pedicle biopsy was taken and antifungal treatment started. Tuberculosis (TB) has been described as an ancient infec- tious disease with evidence being discovered in centuries- old skeletal remains [8]. Moreover, it is the most common cause of spinal infection in south Asian population [9]. In recent decades, there has been a signifcant resurgence of TB (Tuberculosis), causing 2-3 million deaths annually worldwide [10, 11]. Due to the frequent prevalence of TB in spine, it is a common practice to consider Koch’s spine (TB) as the frst diferential in all spinal infections in developing nations. Many of these patients get better with anti-Koch’s therapy without the surgery [12]. Hence it is a common practice to start anti-Koch’s therapy in patients while the biopsy report is awaited [12]. However, rarely, other organisms besides TB could be a reason for such an infection [13]. Tis is the frst case report of Pheohyphomycosis causing spinal infection in an immunocompetent host. 2. Case Report A 29-year-old immunocompetent male patient presented to the outpatient department with complaints of gradually increasing low back pain since one and a half years. Te pain Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2016, Article ID 8705204, 5 pages http://dx.doi.org/10.1155/2016/8705204