Metagenomic next-generation sequencing enabled diagnosis of Aspergillus spondylitis in an immunocompetent patient: a case report and literature review

Abstract

Background: Aspergillus fumigatus spondylitis is a rare fungal spondylitis that often occurs in immunocompromised patients. This article reports a case of Aspergillus spondylitis with specific image signs, which is rarely reported in an immunocompetent patient.

Case presentation: This is a case of L3-4 segmental Aspergillus spondylitis diagnosed. The diagnosis was confirmed by intraoperative metagenomic next-generation sequencing (mNGS) testing of the diseased tissue. The patient was treated with voriconazole and underwent surgical debridement and internal fixation with pedicle screws.

Conclusion: The diagnosis of Aspergillus spondylitis is often delayed or missed. Doctors should consider Aspergillus spondylitis in the differential diagnosis of unexplained low back pain so that appropriate treatment can be administered to prevent spinal cord injury and disability. Aspergillus spondylitis usually results in endplate inflammatory response line on fluid or enhancement sequences and a diffuse low signal in the diseased vertebral body on T2-weighted imaging (T2WI). It also results in large paraspinal abscesses, which requires further research to better differentiate between Aspergillus spondylitis and tuberculous spondylitis. Prompt diagnosis and treatment can improve the patient's prognosis.

Keywords: Aspergillus; Aspergillus fumigatus; clinical features; immunocompetent; infectious spondylitis.

FIGURE 1

Figure (A) shows the enhancement sequence, with the endplate inflammatory reaction line indicated by the white arrow. Figures (B,C) display axial and coronal enhancement, respectively, highlighting inflammatory involvement of the surrounding soft tissues. Figure (D) shows the T2WI sequence, with density 1 measuring 147 and density 2 measuring 90.

FIGURE 2

Figures (A,B) display the postoperative frontal and lateral plain radiographs, respectively. Figure (C) illustrates the histopathological findings of the postoperative vertebral body and disk. The affected intervertebral disk and adjacent vertebral body tissue were predominantly composed of fibrous connective tissue, with localized areas of hemorrhage, necrosis, and scattered neutrophilic infiltration. The magnification of the upper image is 10×, while that of the lower image is 4×.