Aspergillosis Osteomyelitis of the Mandible: A Case Report and Literature Review

Abstract

Aspergillosis is an uncommon fungal infection caused by Aspergillus species, predominantly affecting immunocompromised individuals. While pulmonary involvement is common, extrapulmonary manifestations such as osteomyelitis are uncommon. Aspergillus osteomyelitis of the mandible is an exceptionally rare and life-threatening condition, posing significant diagnostic and therapeutic challenges. We present the case of a 13-year-old immunocompromised patient diagnosed with this condition. The patient presented with persistent jaw pain, swelling, and radiographic evidence of extensive bone destruction. Diagnosis was confirmed through fungal cultures and histopathological examination, which identified Aspergillus species. The patient underwent surgical debridement and prolonged antifungal therapy, leading to clinical improvement. Aspergillus osteomyelitis of the mandible is exceedingly rare, with only a few cases reported in the literature. Early diagnosis is crucial to prevent further bone destruction and associated complications. This case underscores the importance of considering fungal infections in the differential diagnosis of osteomyelitis, particularly in at-risk populations. It also emphasizes the potential role of antifungal prophylaxis in reducing the severity of invasive fungal infections when they occur. Managing this condition presents significant challenges, including the need for aggressive antifungal therapy and the risk of recurrence.

Keywords: Aspergillus osteomyelitis; bone destruction; case report; fungal infection; immunocompromised; mandible; treatment.

Figure 1.

Axial post-contrast CT (soft tissue window) revealed marked soft tissue thickening and swelling in the left mandibular region without evidence of fluid collection. Inflammatory changes extend into the adjacent subcutaneous tissues, with associated myositis of the left masseter and medial pterygoid muscles (Red asterisks). Notably, mild asymmetry and compression of the aeropharyngeal crossroads suggest a mass effect due to the inflammatory process (Yellow asterisk). These findings are consistent with left submandibular bacterial cellulitis with deep space involvement.

Figure 2.

Intraoral examination revealing a loose, non-detachable bone sequestrum, approximately 1.5 cm in diameter, located in the vestibular region of the left mandibular body. The sequestrum exhibited a dark, necrotic appearance and was minimally mobile within the surrounding soft tissues suggesting an ongoing inflammatory process and the need for further intervention (White circle).

Figure 3.

Orthopantomogram (OPG) revealed interproximal bone loss between teeth 36 and 37 (Red circle).

Figure 4.

A sagittal CBCT image demonstrated cortical bone destruction around teeth 36 and 37, characterized by loss of lamina dura of the tooth 36 with associated radiolucencies. Furcation involvement was observed in tooth 36 (Yellow arrow).

Figure 5.

An axial CBCT image revealed cortical bone destruction around teeth 36 and 37, characterized by the presence of radiolucencies, and thin buccal sequestrum (Yellow arrow).

Figure 6.

Intraoperative clinical view demonstrating the surgical site following meticulous debridement. The surgical field reveals clean, well-defined bone margins after complete removal of the sequestrum and the surrounding inflamed granulation tissue. The extent of the bony defect and the thoroughness of the surgical intervention are clearly evident.

Figure 7.

Surgical removal of the movable sequestrum, measuring approximately 1.5 cm. The sequestrum exhibited a yellowish, necrotic appearance.

Figure 8.

Histopathological examination of tissue sections stained with hematoxylin and eosin revealed the presence of septate, branching hyphae consistent with Aspergillus species ((A) ×200, (B) ×400). (Black arrow).

Figure 9.

Histopathological examination of tissue sections revealed the presence of septate, branching hyphae consistent with Aspergillus species. Special stains, including Periodic Acid-Schiff (PAS) and Grocott’s methenamine silver (GMS) stains, confirmed the fungal elements ((A) PAS×200, (B) GMS×400).

Figure 10.

Mucosal healing was satisfactory 15 days postoperatively, demonstrating complete wound closure with minimal signs of inflammation and no evidence of dehiscence or complications that could compromise oral function.