Spinal Aspergillus vertebral osteomyelitis with extradural abscess:: Case report and review of literature

BACKGROUND Spinal extradural abscesses caused by Aspergillus species are rare and occur mostly in immunocompromised patients or in patients with Aspergillomas elsewhere in the body. In this report, the authors draw attention to a rapidly developing syndrome of extradural compressive myelopathy in an immunocompetent patient. Only four other cases have been reported previously. CASE DESCRIPTION A 35-year-old female presented with rapidly progressive painful paraparesis progressing to paraplegia in 15 days despite adequate empiric antitubercular therapy. Magnetic resonance imaging (MRI) revealed D11 vertebral body destruction and an extradural mass compressing the cord from D10 to D12. The patient underwent a D11 corpectomy and spinal stabilization with an iliac bone strut graft, 'Z' Plate and screw fixation. The biopsy showed fungal hyphae with dichotomous branching diagnostic of Aspergillosis. Despite treatment with Amphotericin B and oral Itraconazole the patient developed rapidly progressive multiorgan failure and expired after 2 months. CONCLUSIONS The authors report the fifth and extremely rare case of Aspergillus vertebral osteomyelitis with an extradural abscess in an immunocompetent patient. Therapy is controversial and predicated on the use of highly toxic drugs with inconsistent efficacies. Mortality remains grievously high. (C) 2004 Elsevier Inc. All rights reserved.