A rare case of spontaneous Aspergillus spondylodiscitis with epidural abscess in a 45-year-old immunocompetent female

Abstract

Vertebral osteomyelitis and discitis are mainly due to bacterial infections though fungal infections are one of the important causes of morbidity and mortality in immunocompromised patients. Aspergillus involving intervertebral disc space is extremely rare. We report a case of aspergillosis of intervertebral L5-S1 disc space with spinal epidural abscess in an immunocompetent 45-year-old female which can add on to a few case reports described in literature as well as an insight for clinicians regarding this rare spontaneous infection in an immunocompetent patient.

Osteomyelitis of the Hip secondary to Aspergillus fumigatus - A Case Report and Comprehensive Review of the Literature

“…The incidence of Aspergillus affecting the bone among all cases of invasive Aspergillosis is thought to be around 3% [11,12]. In a series by Horn et al, the incidence of invasive Aspergillosis was 2.6%, similar to those reported by Denning and Stephen in 1990 [12].…”

Imaging Spectrum of Invasive Fungal and Fungal-like Infections

“…Fungal discitis and osteomyelitis may spare the intervertebral disk space and span multiple vertebral levels to result in a gibbus deformity. This finding is also seen with the discitis and osteomyelitis that result from tuberculosis (16,17). Contrast-enhanced MR imaging is the most sensitive imaging modality for examining patients with musculoskeletal fungal and fungal-like infections, as it depicts focal or diffuse marrow involvement as T1-hypointense or T2-hyperintense foci that enhance on contrast-enhanced T1-weighted images.…”

“…CT is often the initial imaging examination of choice and is the preferred method for evaluation of possible osseous destruction. Common CT findings include mucosal thickening and softtissue attenuating material in the sinus cavities ( Fig 2) (16). Inflammatory changes in the orbital fat and exophthalmos are signs of orbital invasion.…”

“…Although pyogenic infections remain more common overall in immunocompromised individuals, the incidence of fungal bone and joint infections has increased in this population (16). Infections typically result from hematogenous spreading or direct extension.…”

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

“…As the rate of immunocompromised status among the general populace increases, the occurrence of fungal infections observes a proportional rise in prevalence [10][11][12]. In addition, fungal infections have been of epidemiological interest as their rarity yet increasing prevalence brings about an awareness in all of its aspects including pathophysiology and management.…”