Vertebral osteomyelitis due to Aspergillus fumigatus in a patient with chronic granulomatous disease successfully treated with antifungal agents and interferon-gamma.
We report a case of invasive aspergillosis due to Aspergillus fumigatus involving the cervical and thoracic vertebrae and upper mediastinum of a 17 year-old Saudi male with chronic granulomatous disease (CGD). The patient did not respond to a long course of liposomal amphotericin B but did to surgical drainage and a combination of caspofungin and itraconazole with subsequent suppression with oral voriconazole. Fourteen months after the start of therapy, the patient had anterior dislocation of T2 thoracic vertebra with cord transection and quadriplegia. He was then treated intravenously with liquid itraconazole and interferon-gamma. The patient made a remarkable recovery over a 2-year period and was eventually able to walk independently. Thus, a combination of antifungals and interferon-gamma may have resulted in the positive outcome in this case.
Al-Tawfiq
Jaffar A
JA
Internal Medicine Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia. jaffar.tawfiq@aramco.com
Al-Abdely
Hail M
HM
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D000077336:Caspofungin; D002574:Cervical Vertebrae / Q000382:microbiology* / Q000473:pathology; D004322:Drainage; D054714:Echinocandins / Q000627:therapeutic use; D006105:Granulomatous Disease, Chronic / Q000150:complications; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use*; D017964:Itraconazole / Q000627:therapeutic use; D055666:Lipopeptides; D008297:Male; D010019:Osteomyelitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D011743:Pyrimidines / Q000627:therapeutic use; D012529:Saudi Arabia; D013904:Thoracic Vertebrae / Q000382:microbiology* / Q000473:pathology; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D007371:Interferon-gamma; D000077336:Caspofungin; D065819:Voriconazole