A rare case of spontaneous Aspergillus spondylodiscitis with epidural abscess in a 45-year-old immunocompetent female
The present case report is about a 45-year-old female patient who presented with low backache for the past 1 month and bilateral lower limb weakness. There was no history of fever, cough or weight loss. She was a known diabetic on treatment since 18 months. Clinical examination revealed tenderness over S1 region with dorsiflexors weakness on both sides. Routine laboratory investigations were within the normal limits. Human immunodeficiency virus antibodies and hepatitis B surface antigen was negative. Magnetic resonance imaging of spine performed showed L5-S1 endplate and intervertebral disc destruction, altered signal intensity changes and anterior epidural granulation tissue/abscess measuring 7.4 mm in thickness, causing spinal encroachment at the same level. Para-discal marrow edema, end plate erosions, with small prevertebral, paravertebral and ventral epidural abscess lesions causing compression of cauda equina. Diagnosis of paradiscal infective spondylodiscitis at L5-S1 disco-vertebral unit was made []. Surgical posterior decompression laminectomy of L5-S1 was done and part of L5-S1 disc and epidural granulation/abscess removed after laminectomy was sent for histopathological examination and for culture.\nGross examination revealed fragmented pieces of gray white soft-tissue of about 2 cc volume. Sections studied from received material showed hyalinized fibro-collagenous tissue, fragments of skeletal muscle, mature adipose tissue, foci of degenerated bony trabeculae and inflammatory cells. The admixed foci showed large areas of hemorrhage, granulation tissue infiltrated by mixed inflammatory infiltrate, necrosis with multiple fragmented viable and degenerated fungal hyphae invading the tissue. Hyphae were uniform, narrow with regular septation and acute angle branching []. Periodic acid Schiff stain confirmed the fungal hyphae. The culture confirmed growth of Aspergillus fumigatus []. The patient was started on oral itraconazole 200 mg twice daily for 3 months. Patient is clinically improving since 9 months after surgery.