title: An immunocompetent patient with primary Scedosporium apiospermum vertebral osteomyelitis.
abstract: Scedosporium apiospermum, the asexual anamorph of Pseudallescheria boydii, is a ubiquitous saprophytic fungus that usually causes cutaneous/subcutaneous infection but may manifest as an invasive disease, often in immunocompromised hosts. Following an extensive literature review, we think that this case represents the first documented report of a primary infection of the spine in an immunocompetent patient. Despite extensive surgical debridement and itraconazole therapy, the patient died of multisystem organ failure of unknown etiology. Our case and three previously reported cases of P. boydii vertebral osteomyelitis highlight the importance of obtaining repeat cultures in patients with culture-negative vertebral osteomyelitis who fail to adequately respond to empiric standard antibacterial and/or antimycobacterial therapy. Combined surgical debridement and antifungal therapy have been required for eradication of P. boydii spinal infections in two previously reported immunocompromised patients, although the optimal antifungal regimen for this infection has not been established.
authors.affiliation: Department of Neurosurgery, Neuroscience Institute, University of Cincinnati College of Medicine, Ohio 45267-0515, USA.
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Levine
authors.forename: Ryu
authors.initials: R
authors.lastname: Kurokawa
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Fichtenbaum
authors.forename: John A
authors.initials: JA
authors.lastname: Howington
authors.forename: Charles
authors.initials: C
authors.lastname: Kuntz
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D021681:Scedosporium; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000935:Antifungal Agents