Aspergillus terreus spondylodiscitis following an abdominal stab wound: a case report

Journal of Medical Case Reports, 2019 · DOI: https://doi.org/10.1186/s13256-019-2109-5 · Published: April 30, 2019

Immunology Orthopedics Research Methodology & Design

Simple Explanation

This case report describes a rare instance of spondylodiscitis, an infection of the intervertebral disc and adjacent vertebrae, caused by the fungus Aspergillus terreus following a penetrating abdominal injury. The patient, a 74-year-old man, sustained an abdominal stab wound and later developed back pain and neurological symptoms. The infection was confirmed by isolating Aspergillus terreus from the affected area. Treatment involved surgery and antifungal medication, leading to a successful recovery. This is the first reported case of Aspergillus terreus spondylodiscitis resulting from a penetrating abdominal injury.

Study Duration

2 years

Participants

A 74-year-old Japanese man

Evidence Level

Level 4: Case Report

Key Findings

1
Aspergillus terreus spondylodiscitis can occur following a penetrating abdominal injury, likely due to direct inoculation of the fungus.
2
The patient presented with back pain, numbness of both legs, and inability to walk 13 weeks after the initial injury.
3
Surgical intervention, including partial laminectomy and anterior fusion, combined with voriconazole administration, led to complete recovery of neurological function and resolution of back pain.

Research Summary

This case report details a 74-year-old man who developed Aspergillus terreus spondylodiscitis following an abdominal stab wound, a previously unreported occurrence. The patient's condition was characterized by back pain, neurological deficits, and radiological evidence of vertebral infection, ultimately requiring surgical intervention and antifungal therapy. The successful outcome highlights the importance of considering fungal infections in patients with penetrating trauma and subsequent spinal infections.

Practical Implications

Increased Awareness

Clinicians should consider fungal infections like Aspergillus terreus in the differential diagnosis of spondylodiscitis, especially in patients with a history of penetrating trauma.

Early Diagnosis and Treatment

Prompt diagnosis through microbiological testing and appropriate antifungal therapy are crucial for successful management of Aspergillus terreus spondylodiscitis.

Surgical Management

Surgical intervention, including debridement and spinal stabilization, may be necessary in conjunction with antifungal treatment to achieve optimal outcomes.

Study Limitations

1
This is a single case report, limiting the generalizability of the findings.
2
The exact mechanism of fungal inoculation, while strongly suspected to be direct, could not be definitively proven.
3
The patient's specific risk factors for fungal infection, beyond the penetrating injury, were not fully explored.

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