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Vertebral Aspergillus osteomyelitis and acute diskitis in patients with chronic obstructive pulmonary disease
M Martinez1, A S Lee, W C Hellinger
1Department of Internal Medicine, Mayo Clinic Jacksonville, FL 32224, USA.
Abstract:
Aspergillus osteomyelitis of the spine with acute diskitis has been well documented in immunocompromised hosts but is rare in immunocompetent patients. Predisposing factors to infection are prolonged neutropenia, hematologic malignancies, chemotherapy, history of prior spinal trauma or surgery, allograft transplantation, or any condition requiring the use of long-term immunosuppressive agents or systemic corticosteroids. Patients with chronic obstructive pulmonary disease (COPD) treated with systemic corticosteroids for either long-term management or frequent exacerbations are at potential risk for such infections. Patients with severe COPD treated primarily with inhaled corticosteroids are considered immunocompetent. This report describes 2 cases of Aspergillus osteomyelitis with acute diskitis in apparently immunocompetent patients with COPD who, aside from brief courses of systemic corticosteroids, were using inhaled corticosteroid therapy. One patient was treated with intravenous amphotericin B alone, whereas the other received amphotericin B and underwent surgical debridement. Both have done well and were symptom free at 6-month follow-up.
Insights
Aspergillus osteomyelitis of the spine is rare in immunocompetent patients. This study highlights two cases in individuals with chronic obstructive pulmonary disease (COPD) using inhaled corticosteroids, suggesting a potential risk.
Area of Science:
- Infectious Diseases
- Spinal Surgery
- Pulmonology
Background:
- Aspergillus osteomyelitis of the spine with acute diskitis is typically seen in immunocompromised individuals.
- Risk factors include neutropenia, malignancies, chemotherapy, prior spinal trauma/surgery, transplantation, and long-term immunosuppressants or systemic corticosteroids.
- Patients with severe chronic obstructive pulmonary disease (COPD) on systemic corticosteroids are at risk; those on inhaled corticosteroids are generally considered immunocompetent.
Observation:
- This report details two cases of Aspergillus osteomyelitis with acute diskitis in apparently immunocompetent patients with COPD.
- Both patients were primarily using inhaled corticosteroid therapy, with only brief courses of systemic corticosteroids.
- One patient received intravenous amphotericin B; the other had amphotericin B and surgical debridement.
Findings:
- Successful treatment outcomes were achieved in both cases.
- Patients were symptom-free at a 6-month follow-up.
- Inhaled corticosteroid use in COPD patients may be associated with a risk of Aspergillus spinal infections, even in those considered immunocompetent.
Implications:
- This suggests a need to consider Aspergillus spinal infections in immunocompetent COPD patients using inhaled corticosteroids presenting with spinal pain and diskitis.
- Early diagnosis and appropriate treatment, including antifungal therapy and potentially surgery, are crucial for favorable outcomes.
- Further research may be warranted to elucidate the precise mechanisms and risk stratification for this rare complication.