Cervical spondylodiscitis caused by Aspergillus in a non-immunocompromised patient: a case report

Abstract

Spondylodiscitis caused by Aspergillus spp. is a rare but serious infection, making it particularly challenging to diagnose and manage. We report a case of a 53-year-old man presenting with neck pain and progressive quadriparesis. Neurological examination revealed power of 3/5 in the upper limbs and 1/5 in the lower limbs, with a modified Nurick grade VI and mJOA score of 9. He had chronic liver and kidney disease but no known immunosuppression. Laboratory investigations showed normal white blood cell (WBC) count, elevated erythrocyte sedimentation rate (ESR) (83 mm/hour), C-reactive protein (CRP) (33 mg/dl), and thrombocytopenia. Initial imaging suggested C5-C6 spondylodiscitis with vertebral destruction and an epidural abscess. A presumptive diagnosis of tubercular spondylodiscitis was made. The patient underwent C5-C7 laminectomy with evacuation of the abscess. Histopathology revealed fungal hyphae of Aspergillus and Candida (PAS and GMS positive). Cultures confirmed Aspergillus spp. He was started on liposomal Amphotericin B and Voriconazole. Due to persistent cord compression on follow-up magnetic resonance imaging (MRI), he underwent C5-C6 corpectomy with iliac crest bone graft fusion and anterior plating. Intraoperatively, C5-C6 vertebrae were destroyed with surrounding inflammatory tissue. Postoperative antifungal therapy continued for two months. This case emphasizes that Aspergillus spondylodiscitis, although rare, should be considered in culture-negative or non-resolving spinal infections, especially in patients with chronic illnesses. Early imaging, histopathology, and timely antifungal therapy with surgical intervention are crucial for favorable outcomes.