Vertebral osteomyelitis and epidural abscess due toAspergillus nidulansresulting in spinal cord compression: Case report and literature review

Abstract

Vertebral osteomyelitis caused by Aspergillus nidulans is rare and usually affects immunocompromised patients. This report presents a case of thoracic vertebral osteomyelitis with epidural abscesses due to A. nidulans in a 40-year-old immunocompetent female who presented with back pain, numbness and weakness of both lower limbs. Magnetic resonance imaging demonstrated osteomyelitis involving the thoracic (T)1-T3 vertebral bodies with epidural abscesses, resulting in spinal compression. The patient underwent a decompression laminectomy of T1-T3 and debridement of the thoracic epidural inflammatory granuloma. Histopathology revealed fungal granulomatous inflammation. The patient received 6 mg/kg voriconazole every 12 h (loading dose on day 1) followed by 4 mg/kg voriconazole twice daily for 1 month, administered intravenously. The patient returned with recurrent back pain 16 months after initial presentation. A. nidulans was identified by fungal culture and polymerase chain reaction. The patient showed no evidence of recurrence 1 year after a 6-month course of oral voriconazole. The key to the effective treatment of Aspergillus osteomyelitis is not to excise the abscess, but to administer systemic antifungal drug therapy.

Aspergillus spinal epidural abscess: case presentation and review of the literature

“…This was decided based on lack of neurological deficits on presentation and significant improvement of the abscess on MRI following administration of antifungal therapy. This supports the view that effective treatment for ASEA and osteomyelitis should be centered on systemic antifungal therapy, with surgical intervention acting as a supplementary role to ensure complete clearance of the infection [3,19,28]. Voriconazole and Micafungin were used and the authors report an adequate outcome with this combination of antifungals.…”

“…Treatment must be administered until symptoms resolve with concordant clearance of the abscess on imaging and continued for multiple months [8]. In addition, symptomology dictates the protocol for surgery-those lacking neural compression may be treated medically, but only with very close monitoring [7,28]. Unfortunately, despite treatment, the condition is associated with a high long-term mortality rate, and many patients have persistent symptoms, such as paraplegia and various serious complications ranging from hemorrhage to multi-organ failure.…”

“…Duration of antifungal treatment should be at least 3-6 months or a longer length of time [16,27]. While surgical excision should be considered in cases with cord compression and for relief of neurological symptoms and those that don't resolve with drug treatment alone [3,6,23,28]. Additionally, we recommend surgery for large collections, patients with neurological symptoms, especially those that are progressive, when diagnosis is very uncertain, and there is lack of response to medical management alone.…”

Atypical Fungal Vertebral Osteomyelitis in a Tsunami Survivor of the Great East Japan Earthquake

“…[12][13][14][15] Moreover, standard laboratory parameters and imaging examinations are usually insuffi cient to distinguish fungal vertebral osteomyelitis from bacterial vertebral osteomyelitis. Therefore, we should bear in mind that near-drowning victims, especially those exposed to dirty water, are at high risk of fungal vertebral osteomyelitis and early intervertebral disc biopsies should be strongly considered to identify the causative fungi, if initial antibiotic therapy proves ineffective.…”

Paraplegia Caused by Infectious Agents; Etiology, Diagnosis and Management

“…Aspergillus may lead to epidural abscesses [58,59], kyphosis, discharging sinus in the back, vertebral destruction and paraplegia [60]. Spondylodiscitis has been reported due to candida [61].…”