Spondylodiscitis by Aspergillus nidulans: A Diagnostic Challenge

Abstract

Fungal infections are significant causes of morbidity and mortality in immunocompromised patients. Aspergillus spondylodiscitis is an uncommon manifestation of invasive aspergillosis and a significant cause of death and frailty. We report a case of spondylodiscitis caused by Aspergillus nidulans section in an HIV patient with Burkitt's lymphoma, who presented with long-term lower back pain and weakness of the lower limbs. Initial MR imaging missed the lesion. Emergent decompression surgery was performed. Fungal culture on the vertebral disc revealed the agent that was later confirmed by sequencing the ITS region of ribosomal DNA genes. Voriconazole was the chosen treatment, and the patient improved. This case demonstrates how difficult a diagnosis can be if we are not considering it. J Microbiol Infect Dis 2021; 11(3): 162-165.

Keywords

• Aspergillus nidulans section
• Spondylodiscitis
• Voriconazole

References

1. 1. Patterson TF, Iii RT, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. IDSA 2016; 63, 1–60.
2. 2. Asare KA, Jahng M, Pincus JL, Massie L, Lee SA. Sternal osteomyelitis caused by Aspergillus fumigatus following cardiac surgery: Case and review. Med Mycology Case Rep 2013; 2(1), 4-6.
3. 3. Gamaletsou MN, Rammaert B, Bueno MA, et al. Aspergillus osteomyelitis: Epidemiology, clinical manifestations, management, and outcome. J Infect 2014; 68(5), 478–493.
4. 4. Vinas FC, King PK, Diaz FG. Spinal Aspergillus Osteomyelitis. Clin Infect Dis 1999; 28(6), 1223–1229.
5. 5. Gabrielli E, Fothergill AW, Brescini L, et al. osteomyelitis caused by Aspergillus species: A review of 310 reported cases. Clin Microbiol Infect 2014; 20(6), 559–565.
6. 6. Bastos RW, Valero C, Silva LP, et al. Functional Characterization of Clinical Isolates of the Opportunistic Fungal Pathogen Aspergillus nidulans. mSphere 2020; 5(2), 1–22.
7. 7. Dotis J, Roilides E. Osteomyelitis due to Aspergillus spp. in patients with chronic granulomatous disease: comparison of Aspergillus nidulans and Aspergillus fumigatus. Int J Infect Dis 2004; 8(2):103-110.
8. 8. Gentile L, Benazzo F, De Rosa F, et al. A systematic review: characteristics, complications and treatment of spondylodiscitis. European Review for Medical and Pharmacological Sciences 2019; 23(2):117–128.

9. 9. Jiang Z, Wang Y, Jiang Y, Xu Y, Meng B. Vertebral osteomyelitis and epidural abscess due to Aspergillus nidulans resulting in spinal cord compression: Case report and literature review. Journal of International Medical Research 2013; 41(2), 502–510.
10. 10. Koehler P, Tacke D, Cornely O. A. Aspergillosis of bones and joints - a review from 2002 until today. Mycoses 2014; 57(6), 323–335.
11. 11. Van Ooij A, Beckers JMH, Herpers MJHM, Walenkamp GHIM. Surgical treatment of aspergillus spondylodiscitis. European Spine Journal 2000; 9(1), 75–79.
12. 12. Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group education and research consortium. Clinical Infectious Diseases 2020; 71(6), 1367–1376.
13. 13. Lyons MK, Neal MT, Patel NP, Vikram HR. Progressive Back Pain due to Aspergillus nidulans Vertebral Osteomyelitis in an Immunocompetent Patient: Surgical and Antifungal Management. Case Report Orthoped 2019; 1–4.
14. 14. Studemeister A, Stevens DA. Aspergillus vertebral osteomyelitis in immunocompetent hosts: Role of triazole antifungal therapy. Clin Infect Dis 2011; 52(1).