A rare etiology of cauda equina syndrome

Abstract

Fungal infections of the spine are very rare and usually seen in immunocompromised patients. Acute cauda equina syndrome presenting in an immunocompetent patient is usually due to a prolapse of the intervertebral disc. Infective pathology caused by Mycobacterium tuberculosis with epidural collection can also have a similar presentation. We present a case of spinal epidural abscess caused by Aspergillus fumigatus, presenting as acute cauda equina syndrome. To the best of our knowledge, spinal aspergillosis presenting as cauda equina syndrome in an immunocompetent patient has not been reported before in the English-language based medical literature. Surgical decompression with antifungal treatment with oral itraconazole yielded a good recovery.

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

“…[10] Only six cases of vertebral osteomyelitis with spinal epidural abscess in immunocompetent individuals are reported until 2010. [11]…”

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

“…A common theme among patients with ASEA is immunosuppression, which can be a result of various conditions, including intravenous drug abuse, corticosteroid therapy, and HIV status [5,7,24,25]. Invasive Aspergillus is particularly prevalent in cases of damaged phagocytic function, as in chronic granulomatous disease [4,6]. Other patients at risk for Aspergillus infection include those with a history of renal transplant, liver cirrhosis, and bodily prosthetics [4,8,25].…”

“…The primary mode of treatment in patients listed in Table 2 was a combination of antifungals and surgical decompression and debridement. Standardizing management is difficult for this condition, though surgical drainage combined with intravenous antifungal therapy seems to be the most common approach [6,8,16]. While amphotericin B was frequently used in earlier reported cases, it is nephrotoxic and has reportedly been found to be ineffective in [3,6,9,16].…”

“…Standardizing management is difficult for this condition, though surgical drainage combined with intravenous antifungal therapy seems to be the most common approach [6,8,16]. While amphotericin B was frequently used in earlier reported cases, it is nephrotoxic and has reportedly been found to be ineffective in [3,6,9,16]. Second generation triazoles, like Voriconazole, have been shown to be more efficacious and less toxic for the patient on long-term treatment [16].…”

“…Aspergillus infection of the spine can sequentially result in a spinal epidural abscess, typically occurring in young patients [3,4]. Aspergillus spinal epidural abscess (ASEA) usually occurs via hematogenous spread from a respiratory focus, gastrointestinal focus, sinuses, or via contiguous spread following surgery or procedures in the same area [2,[5][6][7][8][9]. ASEA typically occurs in the thoracic or lumbar spine, but has also been reported in the cervical spine [2,8,9].…”