Aspergillus vertebral osteomyelitis after simultaneous kidney-pancreas transplantation

Area of Science:

• Medical Mycology
• Transplantation Surgery
• Infectious Diseases

Background:

• Invasive aspergillosis is a serious opportunistic infection in immunocompromised patients, particularly organ transplant recipients.
• Osteomyelitis, an infection of the bone, is an uncommon but severe manifestation of invasive aspergillosis.
• Spinal involvement presents unique diagnostic and therapeutic challenges in the context of post-transplant immunosuppression.

Observation:

• A 46-year-old male recipient of a simultaneous pancreas and kidney transplant developed Aspergillus osteomyelitis and diskitis of the lumbar spine.
• The patient presented with symptoms indicative of a deep-seated infection in the spinal region.
• Diagnosis was confirmed through needle biopsy, identifying Aspergillus species as the causative agent.

Findings:

• A multimodal treatment approach was employed, including prompt needle biopsy for diagnosis.
• Antifungal therapy involved a combination of caspofungin and amphotericin B, targeting the refractory Aspergillus infection.
• Early surgical intervention was crucial for managing the extent of the spinal infection.

Implications:

• This case highlights the importance of considering rare fungal infections like Aspergillus osteomyelitis in transplant patients with new-onset skeletal pain.
• The successful outcome underscores the efficacy of a combined therapeutic strategy involving early diagnosis, aggressive antifungal treatment, and surgical debridement.
• Reviewing similar cases can refine understanding of clinical presentations, risk factors, and optimal management for spinal aspergillosis post-transplantation.