Treatment of a chronic Scedosporium apiospermum vertebral osteomyelitis. Case report.
Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.
German
John W
JW
Division of Neurosurgery, and College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA. jwgerman@hotmail.com
Kellie
Susan M
SM
Pai
Manjunath P
MP
Turner
Paul T
PT
D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008271:Mycetoma / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D011859:Radiography; D021681:Scedosporium / Q000187:drug effects; D013122:Spinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
D000935:Antifungal Agents