Multidrug-resistant, progressive, invasive diffuse spinal aspergillosis: case report and review of the literature.
The authors describe a 65-year-old man who, after 7 years of complete remission from lung cancer, was found on routine oncologic follow imaging to have lesions on several vertebral bodies. Open biopsy of the affected thoracic vertebrae and surrounding soft tissue were negative for neoplasia. Bacteriology cultures revealed colonies of aspergillus fumigatus in all bone samples. Unlike most reported cases in which vertebral compromise rarely extends to more than two adjacent vertebrae, our patient had extensive compromise of the thoracic spine. This infection progressed despite treatment with antifungal regimens known to be effective, even in immunocompromised patients. Invasive aspergillosis of the spine is a rare and typically occurred in terminal patients. However, the spectrum of hosts and clinical presentations of invasive aspergillosis are increasing, due in part to better medical treatments that prolong the survival of patients with cancer, severe infections, and organ failure. In reviewing the literature, the authors discuss the currently available therapies for such infections of the spine, and highlight the growing incidence these and other formerly rare infections.
Andaluz
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Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, OH 45247-0515, USA. editor@mayfieldclinic.com
Zuccarello
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M
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000150:complications / Q000188:drug therapy; D026141:Drug Resistance, Multiple, Fungal; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology
D000935:Antifungal Agents