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Navigating the Diagnostic Challenge of Aspergillus Spinal Epidural Abscess in an Immunocompetent Patient: A Case Report and Literature Review – Lumbar Spinal Stenosis

The article discusses a rare case of Aspergillus spinal epidural abscess (ASEA) in an 85-year-old male patient without systemic symptoms or a history of immunosuppressive status. The patient presented with falls and lower extremity paralysis, and imaging revealed cord signal changes and spinal stenosis. During lumbar spine exploration, an abscess consistent with Aspergillus was found in the epidural space. Treatment with antifungal therapy resulted in gradual symptom improvement. The article highlights the importance of a multidisciplinary approach for the successful management of ASEA and emphasizes the need for early diagnosis and prompt treatment

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest day surgery hospital in London

Published article

Aspergillus spinal epidural abscess (ASEA) is a rare, life-threatening condition that can cause spinal cord compression with neurologic deficits. The diagnosis of ASEA can be challenging due to the atypical clinical presentation and low prevalence. We describe the successful management of a rare, immunocompetent, 85-year-old male with ASEA at the T12-L1 and L1-L2 levels and present a review of the literature. Based on most case reports and our knowledge, this is a rare presentation of ASEA in a…

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Cureus. 2023 Jul 31;15(7):e42770. doi: 10.7759/cureus.42770. eCollection 2023 Jul.ABSTRACTAspergillus spinal epidural abscess (ASEA) is a rare, life-threatening condition that can cause spinal cord compression with neurologic deficits. The diagnosis of ASEA can be challenging due to the atypical clinical presentation and low prevalence. We describe the successful management of a rare, immunocompetent, 85-year-old male with,

Cureus. 2023 Jul 31;15(7):e42770. doi: 10.7759/cureus.42770. eCollection 2023 Jul.

ABSTRACT

Aspergillus spinal epidural abscess (ASEA) is a rare, life-threatening condition that can cause spinal cord compression with neurologic deficits. The diagnosis of ASEA can be challenging due to the atypical clinical presentation and low prevalence. We describe the successful management of a rare, immunocompetent, 85-year-old male with ASEA at the T12-L1 and L1-L2 levels and present a review of the literature. Based on most case reports and our knowledge, this is a rare presentation of ASEA in a patient without systemic symptoms, leukocytosis, or a history of immunosuppressive status due to chronic steroid use. The patient presented with multiple falls and lower extremity paraparesis with near-complete paralysis of the right lower extremity for a duration of three months. Systemic symptoms of infection were absent and standard lab evaluations were unremarkable. CT imaging identified cord signal changes at the level of T10-T11 and a contrast block at L1 suspicious for spinal stenosis and impingement. During lumbar spine exploration, purulent fluid consistent with an abscess was found in the epidural space. Cultures were forwarded to microbiology and returned with Aspergillus. Postoperatively, Infectious Disease (ID) recommended treatment with voriconazole, cefepime, and vancomycin, which yielded gradual symptom improvement. The successful management of ASEA requires a multidisciplinary approach involving neurosurgeons, infectious disease specialists, radiologists, and physical therapists. Clinicians should be aware of the possibility of ASEA regardless of systemic symptoms, and early diagnosis and prompt treatment with surgical decompression and appropriate antifungal therapy are imperative for successful management.

PMID:37663990 | PMC:PMC10469057 | DOI:10.7759/cureus.42770

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Navigating the Diagnostic Challenge of Aspergillus Spinal Epidural Abscess in an Immunocompetent Patient: A Case Report and Literature Review

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Cureus. 2023 Jul 31;15(7):e42770. doi: 10.7759/cureus.42770. eCollection 2023 Jul.ABSTRACTAspergillus spinal epidural abscess (ASEA) is a rare, life-threatening condition that can cause spinal cord compression with neurologic deficits. The diagnosis of ASEA can be challenging due to the atypical clinical presentation and low prevalence. We describe the successful management of a rare, immunocompetent, 85-year-old male with

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