Journal Article

Spondylodiscitis Due to Aspergillus terreus in an Immunocompetent Host: Case Report and Literature Review

Penn, Pascale, Hoche-Delchet, Cyril, Aguilar, Claire, Bouyer, Benjamin, Blanchi, Sophie, Comacle, Pauline, Le Govic, Yohann, Sandrini, Jeremy

2016

Overview

Aspergillus terreus , a saprophytic fungus, is recognized as an emerging pathogen responsible for various infections in human beings. However, bone and joint involvement is uncommon. We report a rare case of A. terreus spondylodiscitis in a 20-year-old male with a past history of recurrent, incompletely treated pulmonary tuberculosis. Clinical signs at the time of admission included cough, low-grade fever, general weakness and left-sided back pain. Histological examination of spinal biopsy samples revealed lesions of necrosis, granulomatous inflammation and septate hyphae with acute-angle branching. A. terreus was recovered from culture. The patient received antifungal therapy with voriconazole plus caspofungin and underwent surgical debridement. Further investigations revealed no cause of primary immunodeficiency such as chronic granulomatous disease, severe combined immunodeficiency syndrome or disorders of the IL-12/IFNγ signaling pathway. Moreover, HIV serological tests resulted negative and the patient was not under immunosuppressive therapy. Unfortunately, owing to precarity and medication non-adherence, vertebral sequelae occurred. This new report emphasizes the need to consider a fungal infection in patients with spondylodiscitis, regardless of the immune status.

• Publisher: Springer Netherlands,Springer,Springer Nature B.V,Springer Verlag
• Subject: Antifungal Agents - therapeutic use / Aspergillosis - diagnosis / Aspergillosis - drug therapy / Aspergillosis - microbiology / Aspergillosis - pathology / Aspergillus - classification / Aspergillus - isolation & purification / Aspergillus terreus / Back pain / Biomedical and Life Sciences / Biopsy / Care and treatment / Case reports / Caspofungin / Discitis - drug therapy / Discitis - etiology / Discitis - microbiology / Discitis - pathology / Echinocandins - therapeutic use / Eukaryotic Microbiology / Fever / Health aspects / Histocytochemistry / HIV tests / Human immunodeficiency virus / Humans / Immunocompetence / Immunotherapy / Infection / Lentivirus / Life Sciences / Lipopeptides - therapeutic use / Literature reviews / Magnetic Resonance Imaging / Male / Medical Microbiology / Microbial Ecology / Microbiological Techniques / Microbiology / Microbiology and Parasitology / Microscopy / Mycobacterium / Mycology / Mycoses / Plant Sciences / Retroviridae / Spine - diagnostic imaging / Spine - microbiology / Spine - pathology / Tuberculosis / Tuberculosis, Pulmonary - complications / Vertebrae / Voriconazole - therapeutic use / Young Adult