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Case Reports
. 2019 Jul 2:2019:4268468.
doi: 10.1155/2019/4268468. eCollection 2019.

Progressive Back Pain due to Aspergillus nidulans Vertebral Osteomyelitis in an Immunocompetent Patient: Surgical and Antifungal Management

Mark K Lyons  1 , Matthew T Neal  1 , Naresh P Patel  1 , Holenarasipur R Vikram  1
Affiliations
Case Reports

Progressive Back Pain due to Aspergillus nidulans Vertebral Osteomyelitis in an Immunocompetent Patient: Surgical and Antifungal Management

Mark K Lyons et al. Case Rep Orthop. .

Abstract

Case report: Aspergillus osteomyelitis is a destructive and progressive infection that has been described both in immunosuppressed and in immunocompetent hosts. We describe a case of lumbar vertebral osteomyelitis in a 61-year-old immunocompetent patient due to Aspergillus nidulans that was successfully treated with a combination of extensive surgical debridement, spinal stabilization, and a prolonged course of antifungal therapy. Imaging demonstrated findings consistent with L3 discitis. The biopsy grew Aspergillus fungus and was treated with vorconizole. Imaging showed progressive destructive osteomyelitis at L3-L4. Patient underwent anterior L3 and L4 partial corpectomies, anterior interbody fusion L3-L5, and posterior T11-S2 pedicle screw and rod fixation. Antifungal treatment resulted in resolution of infection. Aspergillus markers remain negative. One year following definitive treatment, the patient's back pain remains resolved.

Conclusion: Definitive surgical resection of the infection, spinal stabilization, and aggressive antifungal therapy were required to eradicate the infection.

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Figures

Figure 1
Figure 1
Sagittal STIR MR demonstrating signal abnormality in the L3 disc space with endplate irregularity.
Figure 2
Figure 2
(a, b) Standing anterior-posterior and lateral X-rays demonstrating T11-S2 bilateral pedicle screw and rod fixation with bilateral iliac screws. Anterior interbody L4 and L5 PEEK graft. Anterior L3 intradiscal expandable cage and bone graft.
See this image and copyright information in PMC

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