A case of fungal sepsis due to aspergillus spondylitis followed by cytomegalovirus infection in a renal transplant recipient

Park, S.B.; Kang, Min-Chul; Whang, E.A.; Han, Seungyeup; Kim, H.C.

doi:10.1016/j.transproceed.2004.08.049

Cited by 14 publications

(9 citation statements)

References 4 publications

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“…Spinal cord involvement by Aspergillus is a rare entity and could be in the form of paraspinal abscess, epidural abscess, vertebral osteomyelitis, discitis, or spinal cord necrosis [9]. A similar case scenario of Aspergillus paraspinal abscess causing paraparesis and ultimately death due to fungal sepsis has been described [10]. This case highlights how misdiagnosis at an early stage of a serious infection in a transplant recipient can prove to be fatal.…”

Section: Discussionmentioning

confidence: 90%

Unusual Fungal Infections in Renal Transplant Recipients

Eswarappa

Varma

Madhyastha

et al. 2015

Case Reports in Transplantation

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Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. The causative agent and the risk factors differ depending on the period after the kidney transplant. Also the incidence varies according to the geographical area. We are reporting three cases of fungal infections in renal transplant recipients. Two of them have etiological agents which are common among immunosuppressed patients, but with an atypical clinical presentation, while one of them is a subcutaneous infection caused by a less frequent dematiaceous fungus, Aureobasidium pullulans. These cases highlight how a high index of clinical suspicion and prompt diagnosis is very much essential for better outcome. The emerging fungal infections and paucity of data regarding their management pose a challenge to the transplant physicians.

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Section: Discussionmentioning

confidence: 90%

Unusual Fungal Infections in Renal Transplant Recipients

Eswarappa

Varma

Madhyastha

et al. 2015

Case Reports in Transplantation

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“…Aspergillus spondylitis is often confused with tuberculous spondylitis (3, 10). In a previous case report (3), MR showed involvements of three consecutive vertebral bodies and a well-defined paraspinal mass, and as a result, tuberculous spondylitis was initially considered.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous case report (3), MR showed involvements of three consecutive vertebral bodies and a well-defined paraspinal mass, and as a result, tuberculous spondylitis was initially considered. Finally, the patient was pathologically confirmed as having Aspergillus spondylitis.…”

Section: Discussionmentioning

confidence: 99%

“…Aspergillosis is a rare cause of spondylitis, and early diagnosis by MR imaging and adequate treatment are essential for a good outcome (1-3). Although the MR findings of bacterial spondylitis have been fully described (4, 5), the findings of aspergillus spondylitis have been rarely described, and to the best of our knowledge multilevel involvement of cervico-thoraco-lumbar spine has not been previously reported.…”

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confidence: 99%

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Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report

et al. 2007

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Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient. spergillosis is a rare cause of spondylitis, and early diagnosis by MR imaging and adequate treatment are essential for a good outcome (1 3). Although the MR findings of bacterial spondylitis have been fully described (4, 5), the findings of aspergillus spondylitis have been rarely described, and to the best of our knowledge multilevel involvement of cervico-thoraco-lumbar spine has not been previously reported. Here, we report the MR imaging findings of aspergillus spondylitis involving the cervico-thoraco-lumbar spine in a liver transplant recipient. CASE REPORTA 46-year-old man underwent liver transplantation due to hepatitis B virus cirrhosis in March 2005, and subsequently was treated using routine immunosuppression therapy. However, his early postoperative course was complicated by pulmonary aspergillosis. About 10 weeks after liver transplantation a left lower lobe wedge resection and pathology showed aspergilloma, and about three weeks after this thoracic surgery the patient complained of back pain. Plain radiography of the lumbar spine demonstrated no abnormality, and although his back pain was treated conservatively, the patient complained of progressive back pain.MR imaging of the lumbar spine revealed band-like or diffuse hypointense signals in vertebral bodies L2 to L5 on T1-weighted images (Fig. 1A), which were isointense to slightly hyperintense on T2-weighted images (Fig. 1B). In detail, T1-weighted images showed some hypointense signals with preservation of intranuclear clefts in the L2 3 and L4 5 discs, but disc hyperintensity was absent and intranuclear cleft loss was visualized in the L3 4 disc. In addition, endplate irregularities were apparent in the involved spine. Disc space narrowing was observed at L3 4 and L4 5, and band-like or diffuse enhancement was observed in involved vertebral bodies with an epidural abscess (Fig. 1C). A paraspinal abnormal signal was relatively well-defined (Fig. 1D). The MR based diagnosis was of tuberculous spondylitis rather than pyogenic spondylitis. At surgery, infected granulation tissue and disc material with pus were found at the

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“…Despite improvement of kidney transplantation survival, owing to advances in immunosuppressive therapy, infectious complications continue to be of major concern. Because of the infrequency of post‐transplantation tuberculosis (TB) and a lack of medical awareness, this disease may be misdiagnosed (1). Physicians usually consider Mycobacterium tuberculosis in the differential diagnoses of fever of unknown source after renal transplantation.…”

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confidence: 99%