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Journal of Craniovertebral Junction and Spine
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Year : 2022  |  Volume : 13  |  Issue : 2  |  Page : 204-211

Aspergillus spinal epidural abscess: A case report and review of the literature

1 Department of Neurosurgery, H Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
2 Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
3 Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
4 Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, Italy
5 Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
6 Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Correspondence Address:
Giuseppe Emmanuele Umana
Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Via Messina, 829, 95126 Catania
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcvjs.jcvjs_35_22

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Aspergillus spinal epidural abscess (ASEA) is a rare entity that may mimic Pott's paraplegia as it commonly affects immunocompromised patients. We present one institutional case of ASEA with concomitant review of the literature. A 58-year-old female presented with intermittent low back pain for 10 years recently aggravated and with concurrent spastic paraparesis, fever, and weight loss. Emergent magnetic resonance imaging (MRI) showed T11–T12 epidural abscess with discitis and osteomyelitis. After empirical treatment with antibiotics, computed tomography-guided, percutaneous biopsy with drainage was performed, showing granulomatous tubercular-like collection. Antitubercular therapy was initiated, but after 1 month, the patient's condition deteriorated. Repeat MRI showed growth of the spinal epidural abscess with significant cord compression and vertebral osteomyelitis. T11–T12 laminectomy and tissue removal were performed with a posterior midline approach. Tissue histopathology showed necrotic debris colonies of Aspergillus spp. Antifungal therapy was started, and the patient rapidly improved. ASEA may mimic Pott's disease at imaging, leading to immediate start of antitubercular treatment without prior biopsy, leading to severe worsening of patients' clinical status. Cases of ASEA should be considered at pretreatment planning, opting for biopsy confirmation before treatment initiation so to prevent the occurrence of fatal infection-related complications.

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