Subject: Case report and review of the literature on Aspergillus spondylitis (AS) in immunocompetent (IC).
Method: A diabetic patient 65, IC, developed an external malignant otitis germ culture that has evolved over 18 months to mastoiditis, an osteitis of the skull base and spondylodiscitis C2-C3, despite antibiotic therapy probabilistic anti- P. aeruginosa . Mastoidectomy, a biopsy of the sphenoid and two Aspergillus serology come back negative before a 3 rd serologically discordant back and prevertebral a biopsy finds Aspergillus flavus . The change will be favorable voriconazole given for 1 year. A review of the literature on SA IC is performed occasionally.
Result: PubMed identifies, after excluding immunocompromised patients, 44 cases of SA IC with our patient.These patient of 48 years on average (6-76 years), mostly male (68%) with a predisposing factor (84%) often pulmonary aspergillosis kind (23%), spinal procedures (20%), history pulmonary tuberculosis (14%), IV drug abuse (11%), diabetes (11%). Among them, the SA was acquired mostly through blood (62%) than by contiguity (30%). Fever is rare (20%), but the usual back pain (93%), the most frequently lumbar location (55%), rarely cervical (7%). An epidural abscess is common (25%). Serology is inconstant positive (5/7). The diagnosis is made by biopsy (60%) or surgical approach (40%), and found mainly A. fumigatus (74%) and A. flavus (12%). The antifungal treatment is systematic, often combined with a period ranging from three weeks to 14 months, but voriconazole has been tried in only 7 patients. The treatment has resorted to surgery in 57% of cases. Healing without sequelae is common (16% of deaths, 11% of sequelae) without influence of the surgery nor the choice of antifungal.
Conclusion: SA is rare in the IC and difficult to discuss because of the lower sensitivity of serology in the absence of visceral involvement, and when it proceeds by contiguity. Diagnosis is based on biopsy, ie renew when promoting factor, especially diabetes; whereby the prognosis is good.
Full conference title:
- RICAI 32nd (2012)