Nine cases of intramedullar histoplasmosis have been published in the literature. In six cases, spinal cord compression was associated with brain localization or with contex of disseminated histoplasmosis. The authors are reporting here the third isolated spinal cord compression in immunocompetent 42-year-old African-rabbits breeder, a woman. This case was successfully managed with surgical removal of the lesion associated to itraconazole during 8 months. Intramedullar lesion because of the Histoplasma capsulatum was necrosis granulomatous localized at spinal conus. In conclusion, according to literature data the most frequent spinal cord compression caused by histoplasmosis capsulatum. General risk factors include residence in endemic areas as well as immunosuppression. Endemic areas include Africa, Australia, parts of Eastern Asia, and America (Mississippi, Missouri, and Ohio River valleys). Initial localization was cutaneous. Two histopathological forms reported are abscess and necrotizing granuloma. Management is mainly based on antifungus like itraconazole. Surgery is only necessary for the etiology diagnosis.

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Multifocal skeletal tuberculosis is a rare condition. The diagnosis is difficult and the treatment is delayed in the vast majority of cases. A 30-year-old immunocompetent jobless male complained of thoracic and lumbar spine pain for several weeks, associated with progressive weight loss without fever. Neurological examination was normal. CT scanning demonstrated hypodense multifocal lesions of the spine and the hip. Vertebroplasty was performed successfully. But a pathological examination of the biopsy of spinal lesions was not conclusive. One month later, the patient developed an acute spinal cord compression syndrome. Emergency decompression surgery was performed, which demonstrated the purulent epidural abscess and osteolysis. The pathological examination was in favor of tuberculosis. Despite surgical stabilization and cementoplasty, anti-TB therapy and kinesitherapy, the patient was still significantly limited a few months later with a flaccid paraplegia. TB infection was cleared at the end of the two-phase regimen. Atypical tuberculosis ormultifocal TB poses diagnostic problems especially with metastases, malignant lymphoma, and multiple myeloma. We report this rare case of mutifocal skeletal tuberculosis to show the place of vertebroplasty in the management of spinal tuberculosisor if there is indeed a potential role that vertebroplasty could have played in spreading spinal lesions. The patient was informed that non identifying information from the case would be submitted for publication, and he provided consent.

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