<i>Aspergillus</i> Spinal Epidural Abscess

Abstract

Spinal abscess due to Aspergillus is rare. A young boy with chronic granulomatous disease and aspergillosis of the rib had been treated with antifungal treatment 3 months earlier. The patient presented with a brief history of progressive paraparesis. Imaging showed D9–11 vertebral involvement and destruction of the D10 vertebral body with angulation and a large dorsally placed, multiloculated epidural abscess extending from D6 to L2. There was also extensive granulation anterior to and on either side of the vertebrae. The patient underwent extensive laminectomy and decompression of all the loculi and partial removal of the granulation tissue. Aggressive medical treatment was started. The authors recommend an aggressive surgical and medical approach in such cases of disseminated invasive aspergillosis, even though the result may not be very satisfactory. This report discusses the full clinical profile and management of Aspergillus spinal epidural abscess and emphasizes the need to follow up these cases to detect recurrence and new lesions, even if the patients are on adequate medical treatment. In spite of all efforts, high morbidity and mortality is common in such patients.

A rare etiology of cauda equina syndrome

“…Aspergillus commonly invades an immunocompromised host, which may be due to long-term steroid or immunosuppressive therapy, malignancy, organ transplantation, widespread use of antibiotics, intravenous drug abuse, acquired immunodeficiency syndrome or chronic granulomatous disease [11][12][13][14]. Occasionally, Aspergillus invades an immunologically competent individual, in whom the prognosis is better [11].…”

Infectious Etiologies of Myelopathy

“…Several case reports document SEA due to Candida spp., Aspergillus spp., and Blastomyces dermatitidis. [27][28][29][30][31][32][33][34][35][36][37] Certain patient populations are at higher risk of fungal infections, including those with immunosuppression, indwelling central venous catheters, exposure to broad-spectrum antibiotics and intravenous alimentation, and diabetes mellitus. Treatment includes antifungal agents and decompressive surgery.…”

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco, Portugal): differential palaeopathological diagnosis

“…Conversely, the argument that gibus deformity or extensive kyphosis is an apanage of spinal tuberculosis cannot be suggested, because it was reported on clinical cases of children suffering from aspergillosis (e.g. Kline et al, 1994;Gupta et al, 2001;Thomas et al, 2003;Beluffi et al, 2008). From these evidences, specially the overlapping of bony signs in several clinical entities, it seems reasonable to state that the 212 V. Matos, C. Marques and C. Lopes distinction between fungal skeletal lesions and other infectious spondylitis is probably easier if based on the macroscopic appearance of the lesions rather than in their distribution and severity.…”