Back Pain in a 23-Year-Old Male With X-Linked Chronic Granulomatous Disease

Abstract

Patients with chronic granulomatous disease are at increased risk for invasive aspergillosis. Cryptic Aspergillus species are being increasingly recognized as distinct causes of infection in this population. In this study, we describe the first case of Aspergillus udagawae vertebral osteomyelitis in a patient with X-linked chronic granulomatous disease.

Keywords: Aspergillus species; chronic granulomatous disease; osteomyelitis.

Figure 1.

Computed tomography of the chest from the patient’s first hospitalization. Red arrows indicate (A) cavitation and consolidation from invasive fungal disease; (B) a “reverse halo sign” characteristic of invasion into a blood vessel by Aspergillus species; (C) an inflammatory nodule; and (D) intrafissural inflammatory lymph nodes.

Figure 2.

Magnetic resonance imaging of the vertebral spine. (A) shows a sagittal T1 fat saturated postcontrast image of the infiltrative-enhancing lesion centered at the T2 vertebral body associated with contiguous extra-osseous extension involving the epidural levels from T1 to T3 with cord impingement (white arrow). An axial T2 image in (B) demonstrates bony destruction and cortical breakthrough (white arrow).

Figure 3.

A cottony white mold was isolated from culture (eSwab specimen of the T2 epidural space) after 8 days of growth on Saboraud Dextrose agar at 30°C. Subculture to potato dextrose agar yielded condida after a further 5–7 days of growth, with lactophenol cotton blue prep revealing structures as shown in (A). The colony remained white and produced a lavender-purple diffusible pigment (B).