Vertebral Osteomyelitis due to Aspergillus fumigatus

We report a case of 57-year-old diabetic man presented with progressive neck pain for 4 months followed by weakness and numbness of right arm. MRI of the cervicothoracic spine revealed osteomyelitis and diskitis of the C6-T4 spine with epidural and prevertebral phlegmon. Open bone biopsy and decompression of the T4-5 spine was done and the histopathology demonstrated degenerated fungal hyphae within necrotic cartilage. Bone tissues grew Aspergillus fumigatus. Amphotericin B was administered as a primary drug, followed by voriconazole. However, the treatment was subsequently discontinued due to drug-induced hypersentivity. Amphotericin B was re-administered for 4 weeks, followed by oral itraconazole. After 2 months of the treatment, neck pain, weakness and numbness were improved. To our knowledge, this is the first case report of vertebral aspergillosis from Thailand. (J Infect Dis Antimicrob Agents 2011;28:197202.) Note: This case had been presented and discussed in the Interhospital Case Conference on Infectious Diseases (ICCID), 18 March 2011, Bangkok, Thailand. 1Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. 2Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. 3Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. 4Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. Received for publication: August 11, 2011. Reprint request: Siriorn P. Watcharananan, M.D., Section of Infectious Disease, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. Email: [email protected], [email protected]