Chronic spinal epidural abscess caused by Scedosporium prolificans in an immunocompetent patient

Case report and clinical discussion.

To describe a rare case of chronic spinal epidural abscess caused by Scedosporium prolificans in an immunocompetent patient.

S. prolificans is an emerging multiresistant fungal pathogen that may cause a wide variety of infections, whose severity depends of the patient's immune status.

A 35-year-old Brazilian man developed a 5-year chronic progressive paresis in lower limbs followed by sphincter dysfunction. Spinal magnetic resonance imaging revealed a thoracic-lumbar epidural mass that heterogeneously enhanced gadolinium. Spinal biopsy showed a chronic inflammatory process localized in epidural thoracic spine. S. prolificans was isolated in a specific culture.

He was treated with endovenous voriconazole for 2 weeks followed by oral voriconazole for 90 days. Three months later, a T9-T10 epidural mass was detected on a new magnetic resonance imaging. The abscess was drained, and the culture of the material confirmed the persistence of infection by S. prolificans. A progressive paraparesis due to chronic meningo-myelitis was observed at a 6-month follow-up. Although patient was treated with caspofungin, terbinafine, and voriconazole, no improvement was observed.

S. prolificans can cause chronic epidural abscess and spine infection in immunocompetent patients. The potential resistance of S. prolificans to antifungal agents should be borne in mind.