Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult

Yoon, Kyeong-Wook; Kim, Young‐Jin

doi:10.3109/02688697.2014.957648

Cited by 19 publications

(15 citation statements)

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“…Here, we showed an immunocompetent patient who initially presented with pulmonary granulomatous lesions of undetermined origin and had vertebral osteomyelitis due to Aspergillus a few months later. Aspergillus osteomyelitis is frequently associated with immunosuppression such as organ transplantation, hematopoietic malignancies, diabetes mellitus, or other predisposing conditions [ 1 , 3 ], but it also develops in nonimmunocompromised patients [ 4 , 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, sometimes hyphae are hard to obtain from specimens, because the position and the size of sampling or the amount of bacteria contained in the relevant lesions might have an influence. In one case, hyphae were barely detected in 2 slides among over 100 slides [ 5 ]. Similarly, we failed to find hyphae in abundant lung specimens and could not clearly detect hyphae in lumbar lesions until the last surgery.…”

Section: Discussionmentioning

confidence: 99%

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Aspergillus Vertebral Osteomyelitis Complicating Pulmonary Granuloma in an Immunocompetent Adult

Cen²,

Luo³

et al. 2015

Med Princ Pract

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Objective: The aim of this report is to describe a case with Aspergillus vertebral osteomyelitis complicating pulmonary granuloma in an immunocompetent adult. Clinical Presentation and Intervention: A 53-year-old male patient was found to have lesions on lumbar vertebra 5 months after thoracoscopic resection of pulmonary granuloma that lacked a definite etiology. Three operations on the lumbar lesions were performed successively; however, an Aspergillus infection was not confirmed until hyphae were clearly detected at the last surgery. The patient was treated with voriconazole and recovered well. Conclusion: This case shows that simultaneous occurrence of granulomatous nodules in the lung and vertebral lesions should raise suspicion of aspergillosis, even in immunocompetent patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aspergillus Vertebral Osteomyelitis Complicating Pulmonary Granuloma in an Immunocompetent Adult

Cen²,

Luo³

et al. 2015

Med Princ Pract

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“…In the current case series, 2 patients (2/6) had elevated WBC counts, all 6 patients (6/6) had elevated ESRs, and 4 patients (4/5) had elevated CRP. The imaging manifestations of Aspergillus spondylitis are related to the patient's immune function and course of disease [11,16]. X-ray and CT manifestations are often atypical.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus spondylitis: case series and literature review

Dai

Wang

Yin

et al. 2020

BMC Musculoskelet Disord

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Background: Spinal fungal infections, especially spinal Aspergillus infections, are rare in the clinic. Here, we introduce the clinical features, diagnosis, treatment, and prognoses of 6 cases of Aspergillus spondylitis. Methods: We retrospectively analysed the complete clinical data of patients with Aspergillus spondylitis treated in our hospital from January 2013 to January 2020. Results: Aspergillus fumigatus was isolated in 4 cases, and Aspergillus spp. and Aspergillus niger were isolated in 1 case each. All six patients reported varying degrees of focal spinal pain; one patient reported radiating pain, one patient experienced bowel dysfunction and numbness in both lower limbs, and three patients had fever symptoms. One case involved the thoracic spine, one case involved the thoracolumbar junction, and 4 cases involved the lumbar spine. Three patients were already in an immunosuppressed state, and three patients entered an immunosuppressed state after spinal surgery. All six patients were successfully cured, and five required surgery. Of the 5 patients who underwent surgical treatment, 2 had spinal cord compression symptoms, and 3 had spinal instability. At the end of follow-up, 1 patient reported left back pain and 1 patient reported left limb numbness. Conclusion: The clinical manifestations of Aspergillus spondylitis are non-specific, and the diagnosis depends on typical imaging findings and microbiological and histopathological examination results. When there is no spinal instability, spinal nerve compression symptoms, or progressive deterioration, antifungal therapy alone may be considered. If spinal instability, spinal nerve compression, or epidural abscess formation is present, surgery combined with antifungal therapy is recommended.

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“…1 Several authors reported difficulty in diagnosis of Aspergillus vertebral osteomyelitis in immunocompetent patients until open surgical biopsy or needle biopsy was performed. [8][9][10][11] Treatment of invasive aspergillosis with osteomyelitis should include antifungal therapy, correction of immunosuppression if possible, and surgical source control. There were fewer relapses in patients managed with surgery plus antifungal therapy in comparison with antifungal therapy alone.…”

Section: Reviewedmentioning

confidence: 99%

Invasive Aspergillosis Manifested as Lumbar Vertebral Osteomyelitis in an Immunocompetent Man

Soule

Bearman

2016

Infect Dis Clin Pract

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Aspergillus, a saprophytic fungus ubiquitously present in the environment, is rarely pathogenic in immunocompetent hosts, as such invasive Aspergillus osteomyelitis in immunocompetent hosts is uncommonly reported. A 50-year-old immunocompetent man, intravenous drug user with hepatitis C and diabetes mellitus, presented with lumbago and was diagnosed with L5-S1 discitis/osteomyelitis with associated phlegmon, s1 nerve root impingement, and no epidural abscess in August 2014. Needle biopsy cultures were negative. The patient was readmitted in October 2014 with worsening lumbago after completion of antibiotics. Inflammatory markers were significantly elevated (erythrocyte sedimentation rate = 97 mm in 1 hour; C-Reactive Protein = 13.5 mg/dL) and magnetic resonance imaging demonstrated ongoing acute L5-S1 discitis/osteomyelitis with involvement of vertebral bodies and endplate erosion, progressive impingement of the s1 nerve root, and no epidural abscess. Intraoperative cultures and histopathology were consistent with invasive aspergillosis and was treated successfully with voriconazole. Lumbar vertebral osteomyelitis in immunocompetent patients is a potentially life-threatening diagnosis often made late in the presentation because of nonspecific serologic test options and difficulty culturing fungal organisms. Open biopsy should be obtained when suspicion for a nonbacterial pathogen is high, especially after failure of antibacterial therapy. Aspergillosis should be considered in patients with a history of intravenous drug use, because drugs can be contaminated with Aspergillus. Voriconazole is the antifungal of choice for invasive aspergillosis osteomyelitis with excellent oral bioavailability, bone penetrance, and superior adverse effect profile compared with amphotericin B. Treatment for invasive aspergillosis osteomyelitis should involve both surgical and medical interventions.A spergillus is a saprophytic fungus and often found in decaying organic debris and construction sites. 1 It is the most common mold infection worldwide and rarely pathogenic in immunocompetent hosts. We present a case of Aspergillus lumbar vertebral osteomyelitis in an immunocompetent man. CASE PRESENTATIONA 50-year-old man with hepatitis C, diabetes mellitus type 2, and intravenous drug use sought medical care in August 2014 after experiencing 4 weeks of lumbago. He initially presented to an outside facility where a lumbar spine computed tomography scan suggested osteomyelitis at L5-S1. He denied systemic symptoms but noted increasing lower back pain, worse with ambulation, radicular pain, and plantar anesthesia of the left foot. He was then started on empiric vancomycin and piperacillin/tazobactam and transferred to our facility. A lumbar spine magnetic resonance imaging demonstrated changes consistent with L5-S1 discitis/ osteomyelitis, impingement of the s1 nerve root, but without epidural abscess. At the time of initial presentation, inflammatory markers were not elevated (erythrocyte sedimentation rate [ESR] = 15 mm in 1 hour; CRP = ...

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Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult

Cited by 19 publications

References 0 publications

<b><i>Aspergillus </i></b>Vertebral Osteomyelitis Complicating Pulmonary Granuloma in an Immunocompetent Adult

<b><i>Aspergillus </i></b>Vertebral Osteomyelitis Complicating Pulmonary Granuloma in an Immunocompetent Adult

Aspergillus spondylitis: case series and literature review

Invasive Aspergillosis Manifested as Lumbar Vertebral Osteomyelitis in an Immunocompetent Man

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