title: Thoracic spinal cord intramedullary aspergillus invasion and abscess.
abstract: Invasive central nervous system aspergillosis is a rare form of fungal infection that presents most commonly in immunocompromised individuals. There have been multiple previous reports of aspergillus vertebral osteomyelitis and spinal epidural aspergillus abscess; however to our knowledge there are no reports of intramedullary aspergillus infection. We present a 19-year-old woman with active acute lymphoblastic leukemia who presented with several weeks of fevers and bilateral lower extremity weakness. She was found to have an intramedullary aspergillus abscess at T12-L1 resulting from adjacent vertebral osteomyelitis and underwent surgical debridement with ultra-sound guided aspiration and aggressive intravenous voriconazole therapy. To our knowledge this is the first reported case of spinal aspergillosis invading the intramedullary cavity. Though rare, this entity should be included in the differential for immunocompromised patients presenting with fevers and neurologic deficit. Early recognition with aggressive neurosurgical intervention and antifungal therapy may improve outcomes in future cases.
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA.
authors.forename: Addason F
authors.initials: AF
authors.lastname: McCaslin
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA. Electronic address: rishi.lall@northwestern.edu.
authors.forename: Rishi R
authors.initials: RR
authors.lastname: Lall
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA.
authors.forename: Albert P
authors.initials: AP
authors.lastname: Wong
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA.
authors.forename: Rohan R
authors.initials: RR
authors.lastname: Lall
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sugrue
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Koski
mesh_terms: D000038:Abscess / Q000382:microbiology / Q000473:pathology; D000935:Antifungal Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D018908:Muscle Weakness / Q000209:etiology; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D010019:Osteomyelitis / Q000382:microbiology / Q000473:pathology; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D013116:Spinal Cord / Q000382:microbiology* / Q000473:pathology*; D013396:Suction; D013904:Thoracic Vertebrae / Q000382:microbiology* / Q000473:pathology*; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: Abscess; Central nervous system vasculitis; Fungi; Intramedullary aspergilloma; Neuroaspergillosis; Precursor cell lymphoblastic leukemia-lymphoma