title: Spondylodiscitis Due to Aspergillus terreus in an Immunocompetent Host: Case Report and Literature Review.
abstract: Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen responsible for various infections in human beings. However, bone and joint involvement is uncommon. We report a rare case of A. terreus spondylodiscitis in a 20-year-old male with a past history of recurrent, incompletely treated pulmonary tuberculosis. Clinical signs at the time of admission included cough, low-grade fever, general weakness and left-sided back pain. Histological examination of spinal biopsy samples revealed lesions of necrosis, granulomatous inflammation and septate hyphae with acute-angle branching. A. terreus was recovered from culture. The patient received antifungal therapy with voriconazole plus caspofungin and underwent surgical debridement. Further investigations revealed no cause of primary immunodeficiency such as chronic granulomatous disease, severe combined immunodeficiency syndrome or disorders of the IL-12/IFNγ signaling pathway. Moreover, HIV serological tests resulted negative and the patient was not under immunosuppressive therapy. Unfortunately, owing to precarity and medication non-adherence, vertebral sequelae occurred. This new report emphasizes the need to consider a fungal infection in patients with spondylodiscitis, regardless of the immune status.
authors.affiliation: Laboratoire de Microbiologie, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Comacle
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France. yohann.legovic@chu-angers.fr.|Groupe d'Etude des Interactions Hôte-Pathogène, L'UNAM Université, Université d'Angers, UPRES-EA 3142, Angers, France. yohann.legovic@chu-angers.fr.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Le Govic
authors.affiliation: Laboratoire de Microbiologie, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Hoche-Delchet
authors.affiliation: Laboratoire d'Anatomie et Cytologie Pathologique, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sandrini
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades APHP, 194 rue de sèvres, 75015, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Aguilar
authors.affiliation: Service de Chirurgie Orthopédique et Traumatologie, Hôpital Européen Georges-Pompidou APHP, 20 rue Leblanc, 75908, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bouyer
authors.affiliation: Service des Maladies Infectieuses et Tropicales, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Blanchi
authors.affiliation: Laboratoire de Microbiologie, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Penn
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification*; D001706:Biopsy; D000077336:Caspofungin; D015299:Discitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology*; D054714:Echinocandins / Q000627:therapeutic use; D006651:Histocytochemistry; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008828:Microbiological Techniques; D008853:Microscopy; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000150:complications; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin; D065819:Voriconazole
keywords: Antifungals; Aspergillosis; Aspergillus terreus; Immunocompetent; Spondylodiscitis; Vertebral osteomyelitis