Two different involvement of Aspergillus fumigatus in the same case: endophthalmitis and lumbar spondylodiscitis

G. Dogan1 , O. Tunger1 , F. Kocoglu1 , C. Temiz2 , P. Temiz3 , S. Senol1 , C.B. Cetin1

Author address: 

1 Infectious Diseases And Clinical Microbiology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey, 2Neurosurgery, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey, 3Pathology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey


Case Report: Aspergillus species are mold type fungi that commonly found in nature and especially for immunocompromised people can cause opportunistic infections. Aspergillus-induced endogenous endophthalmitis is a very rare ophthalmic emergency that can result in visual loss. Bone infections caused by Aspergillus species are also rare clinical manifestation especially occurs in immunocompromised patients. In this case report, two rare clinical conditions such as endogenous endophthalmitis and lumbar spondylodiscitis due to Aspergillus are reviewed. A 39-year-old woman with no known underlying disease was admitted to the Ophthalmology Departmant with loss of vision in her left eye. Approximately two months ago, there was a history of antibiotic use (moxifloxacin) for pneumonia. No additional physical examination findings were detected in the patient. Laboratory tests revealed erythrocyte sedimentation rate 59 mm / h, leukocyte count 9.81 103 / /L, hematocrit 34.2%, platelet count 552 103 / /L, neutrophil count 7.53 103 / /L, Creactive protein 1 mg / dl. Vasculitis was detected in ocular angiography and corticosteroid therapy (prednisolone 32 mg) was started by consultation of Rheumatology Department. Lumbar puncture was performed after normal result of cranial MRI that performed for differential diagnosis of vasculitis, and CSF examination was normal. The patient had undergone vitrectomy because the complaint did not regress despite steroid treatment. Direct examination of the vitreous specimen revealed gram positive bacteria and fungi, and intravitreal Liposomal AMB treatment with intravenous liposomal amphotericin-B (LAMB) and moxifloxacin was initiated. Aspergillus fumigatus was grown in vitreous samples. Bronchoscopy was performed and there was no cultural growth in BAL samples. Parenteral antimicrobial treatment was completed and was discharged after 14 days. The patient who had low back pain and morning stiffness was hospitalized in Rheumatology with the preliminary diagnosis of ankylosing spondylitis and received 250 mg intravenous methylprednisolone treatment for 3 consecutive days. Due to the absence of sacroileitis in MR imaging and monitoring of L4-L5 spondylodiscitis, piperacillin tazobactam and daptomycin were started empirically. The patient was than hospitalized in Infectious Diseases. In the pathological examination of the lumbar spine, fungal hyphae were seen and LAMB (3 mg / kg) was added to the treatment because of the positive galactomannan antigen (GMA). The patient whose complaints had regressed and whose GMA was negative was discharged with oral voriconazole after 45 days use of LAMB and 7 days use of parenteral voriconazole. The patient underwent oral voriconazole therapy for 160 days during outpatient follow-up, and regression was detected in control magnetic resonance imaging.

CONCLUSION: In immunosuppressive and immunocompetent patients, fungal agents should be considered in case of treatment failure, and hidden foci such as endocardium, eye and vertebrae must be investigated because of hematogenous transmission.


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Full conference title: 

9th Trends in Medical Mycology Conference 2019
    • TIMM (2019)