Spinal abscess due to Aspergillus is rare. A young boy with chronic granulomatous disease and aspergillosis of the rib had been treated with antifungal treatment 3 months earlier. The patient presented with a brief history of progressive paraparesis. Imaging showed D9–11 vertebral involvement and destruction of the D10 vertebral body with angulation and a large dorsally placed, multiloculated epidural abscess extending from D6 to L2. There was also extensive granulation anterior to and on either side of the vertebrae. The patient underwent extensive laminectomy and decompression of all the loculi and partial removal of the granulation tissue. Aggressive medical treatment was started. The authors recommend an aggressive surgical and medical approach in such cases of disseminated invasive aspergillosis, even though the result may not be very satisfactory. This report discusses the full clinical profile and management of Aspergillus spinal epidural abscess and emphasizes the need to follow up these cases to detect recurrence and new lesions, even if the patients are on adequate medical treatment. In spite of all efforts, high morbidity and mortality is common in such patients.

Beaudoin MG, Klein L: Epidural abscess following multiple spinal anaesthetics. Anaesth Intensive Care 1984;12:163–164.
Byrd WF, Weiner MM, McGee MA: Aspergillus spinal epidural abscess. JAMA 1982;248:3138–3139.
Chee YC, Poh SC: Aspergillus epidural abscess in a patient with obstructive airway disease. Postgrad Med J 1983;59:43–45.
Dubbeld P, van Oostenbrugge RJ, Twinjstra A, Schouten HC: Spinal epidural abscess due to Aspergillus infection of the vertebrae: Report of 3 cases. Neth J Med 1996;48:18–23.
Hendrix WC, Arruda LK, Platts-Mills TA, Haworth CS, Jabour R, Ward GW Jr: Aspergillus epidural abscess and cord compression in a patient with aspergilloma and empyema. Survival and response to high dose systemic amphotericin therapy. Am Rev Respir Dis 1992;145:1483–1486.
Ingwer I, McLeish KR, Tight RR, White AC: Aspergillus fumigatus epidural abscess in a renal transplant recipient. Arch Intern Med 1978;138:153–154.
Wagner DK, Varkey B, Sheth NK, Da Mert GJ: Epidural abscess, vertebral destruction and paraplegia caused by extending infection from an aspergilloma. Am J Med 1985;78:518–522.
Witzig RS, Greer DL, Hyslop NE Jr: Aspergillus flavus mycetoma and epidural abscess successfully treated with itraconazole. J Med Vet Mycol 1996;34:133–137.
Lin MB, Chee SG: Aspergillus infection of the nech with an extradural component: An unusual presentation. Singapore Med J 1995;36:678–681.
D’Hoore K, Hoogmartens M: Vertebral aspergillosis. A case report and review of the literature. Acta Orthop Belg 1993;59:306–314.
Scamoni C, Dario A, Pozzi M, Dorrizzi A: Drainage of Aspergillus ‘primitive’ brain abscess with long-term survival. Case report. J Neurosurg Sci 1990;34:155–158.
Bhattacharya MK, Bhattacharya A, Sridhar K: Fungal infections; in Ramamurthy B, Tandon PN (eds): Textbook of Neurosurgery, ed 2. New Delhi, Churchill Livingstone, 1996, vol 1, pp 553–566.
Kim M, Shin JH, Suh SP, Ryang DW, Park CS, Kim C, Kook H, Kim J: Aspergillus nidulans infection in a patient with chronic granulomatous disease. J Korean Med Sci 1997;12:244–248.
White CJ, Kwon-Chung KJ, Gallin JI: Chronic granulomatous disease of childhood. An unusual case of infection with Aspergillus nidulans var. echinulatus. Am J Clin Pathol 1988;90:312–316.
Segal BH, De Carlo ES, Kwon-Chung KJ, Malech HL, Gallin JI, Holland SM: Aspergillus nidulans infection in chronic granulomatous disease. Medicine (Baltimore) 1998;77:345–354.
Carey ME: Infections of the spinal cord; in Youmans JR (ed): Neurological Surgery, ed 4. Philadelphia, Saunders, 1996, vol 5, pp 3270–3304.
Friedman AH, Bullitt E: Fungal infection; in Wilkins RH, Rengachari SS (eds): Neurosurgery, ed 2. New York, McGraw Hill, 1996, vol 3, pp 3385–3386.
Martinez M, Lee AS, Hellinger WC, Kaplan J: Vertebral Aspergillus osteomyelitis and acute diskitis in patients with chronic obstructive pulmonary disease. Mayo Clin Proc 1999;74:579–583.
Govender S, Rajoo R, Goga IE, Charles RW: Aspergillus osteomyelitis of the spine. Spine 1991;16:746–749.
Lang EW, Pitts LH: Intervertebral disc space infection caused by Aspergillus fumigatus. Eur Spine J 1996;5:207–209.
Bridwell KH, Campbell JW, Barenkamp SJ: Surgical treatment of hematogenous vertebral Aspergillus osteomyelitis. Spine 1990;15:281–285.
Korovessis P, Repanti M, Katsardis T, Stamatakis M: Anterior decompression and fusion for Aspergillus osteomyelitis of the lumbar spine associated with paraparesis. Spine 1994;19:2715–2718.
Hummel M, Schuler S, Weber U, Schwertlick G, Hempel S, Theiss D, Rees W, Mueller J, Hetzer R: Aspergillosis with Aspergillus osteomyelitis and diskitis after heart transplantation: Surgical and medical management. J Heart Lung Transplant 1993;12:599–603.
Anand S, Maini L, Agarwal A, Singh T, Dhal AK, Dhaon BK: Spinal epidural abscess – a report of six cases. Int Orthop 1999;23:175–177.
Sheth NK, Varkey B, Wagner DK: Spinal cord aspergillus invasion – complication of an aspergilloma. Am J Clin Pathol 1985;84:763–769.
Koh S, Ross LA, Gilles FH, Nelson MD Jr, Mitchell WG: Myelopathy resulting from invasive aspergillosis. Pediatr Neurol 1998;19:135–138.
Lang IM, Hughes DG, Jenkins JP, St Clair Forbes W, McKenna F: MR imaging appearances of cervical epidural abscess. Clin Radiol 1995;50:466–471.
Coleman JM, Hogg GG, Rosenfeld JV, Waters KD: Invasive central nervous system aspergillosis: Cure with liposomal amphotericin B, itraconazole, and radical surgery – case report and review of the literature. Neurosurgery 1995;36:858–863.
Artico M, Pastore FS, Polosa M, Sherkat S, Neroni M: Intracerebral Aspergillus abscess: Case report and review of the literature. Neurosurg Rev 1997;20:135–138.
Casey AT, Wilkins P, Uttley D: Aspergillosis infection in neurosurgical practice. Br J Neurosurg 1994;8:31–39.
Baslar Z, Soysal T, Hanci M, Aygun G, Ferhanoglu B, Sarioglu AC, Ulku B: Successfull outcome of aspergillus brain abscess in a patient who underwent bone marrow transplantation for aplastic anemia. Haematologia (Budap) 1997;28:265–271.
Assaad W, Nuchikat PS. Cohen L, Esguerra JV, Whittier FC: Aspergillus discitis with acute disc abscess. Spine 1994;19:2226–2229.
Khanna RK, Malik GM, Rock JP, Rosenblum ML: Spinal epidural abscess: Evaluation of factors influencing outcome. Neurosurgery 1996;39:958–964.
Cuccia V, Galarza M, Monges J: Cerebral aspergillosis in children. Report of three cases. Pediatr Neurosurg 2000;33:43–48.
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