Aspergillus species are uncommon etiologic agents of vertebral osteomyelitis. We describe two patients with lumbar vertebral aspergillosis precipitated by the use of corticosteroids and review 39 cases in the literature. The mean age of the population was 40.04 years. There was male predominance (78% of cases), mainly lumbar involvement (53.7%), and monomicrobial nature of infection; 65.8% of the patients had predisposing factors, while 34.1% had none. Back pain (53.6% of cases) was the predominant symptom, while neurological deficits were present in 29.2% of the patients. White blood cell counts were elevated in 12.2% of the patients, and erythrocyte sedimentation rates were ú40 mm/h in 39%. The overall recovery rate was 68.3%, and the mortality rate was 26.8%. Although aspergillus osteomyelitis is primarily treated medically, certain cases may require surgical intervention.The widespread use of broad-spectrum antibiotics, corticotreatment showed resolution of the brain lesions, and serial determinations of the erythrocyte sedimentation rate (ESR) resteroids, and chemotherapeutic drugs has led to an increased frequency of opportunistic infections. However, the occurrence vealed a return to normal values. Six months later, she was readmitted to the hospital with an acute exacerbation of asthma of these infections in the spinal column is uncommon. Aspergillus is an ubiquitous saprophytic fungus widely disseminated and treated with intravenous steroids. in the environment. Although aspergillus infection may affect Eight months later, she was readmitted to the hospital with normal individuals, it is extremely rare in the absence of immulow-grade fever and unbearable low-back pain. A chest roentnosuppression. We report two cases of vertebral aspergillus genogram was unremarkable. Laboratory examination showed osteomyelitis of the lumbar spine that were precipitated by an ESR of 60 mm/h and a WBC count of 7.3/mm 3 , with 73% intravenous steroid therapy for other systemic diseases. Other segmented cells and 19% lymphocytes. Blood cultures were previously reported cases of spinal aspergillosis are reviewed.negative. Plain roentgenograms demonstrated destruction of the end plates of L5 and S1 vertebrae. An MRI of the lumbar spine showed osteomyelitis and diskitis of the L5-S1 disk Methods space. A MEDLINE search of the English-, French-, and Spanish-The patient underwent laminectomy with open biopsy of the language literature from 1966 to August 1998 and review of disk space and spinal fusion. Pathological examination of a reference lists for additional cases before 1966 yielded 39 cases biopsy specimen showed osteomyelitis with scattered giant of proven vertebral aspergillus osteomyelitis (tables 1 and 2). multinucleate cells containing particles of retractile material. Cases with radiological, gross, or histopathologic evidence of Grocott-Gomori methenamine -silver nitrate staining revealed vertebral aspergillus osteomyelitis were included in the review.fungal hyphae that were septated and branching at about 45Њ The a...

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