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Vertebral osteomyelitis with a rare etiology diagnosed by fine-needle aspiration cytology

Nandeesh B N1, Usha Kini, Betty Alexander

  • 1Department of Pathology, St. John's Medical College and Hospital, Koramangala, Bangalore 560034, India.

Diagnostic Cytopathology
|November 7, 2009
PubMed

Insights

Invasive Aspergillus osteomyelitis of the spine is rare, even in immunocompromised patients. Early cytologic diagnosis via fine-needle aspiration cytology (FNAC) is crucial for timely treatment and recovery.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Orthopedic Surgery

Background:

  • Invasive fungal infections, particularly Aspergillus, are uncommon in immunocompromised patients.
  • Vertebral and intervertebral disc involvement by Aspergillus, with extradural abscess formation, is exceedingly rare.
  • Hematogenous dissemination or direct extension can lead to bone infections in critically ill patients.

Observation:

  • A case of vertebral osteomyelitis caused by Aspergillus was diagnosed in a well-controlled diabetic patient.
  • The patient presented with nonspecific symptoms, initially considered as Pott's spine (tuberculosis of the spine).
  • Diagnosis was confirmed by fine-needle aspiration cytology (FNAC).

Findings:

  • Fine-needle aspiration cytology (FNAC) enabled early diagnosis of vertebral Aspergillus osteomyelitis.
  • The patient had a well-controlled diabetic condition, highlighting that such infections can occur even with managed comorbidities.
  • Nonspecific symptoms and initial radiological findings mimicked Pott's spine, underscoring the need for cytologic confirmation.

Implications:

  • Early cytologic diagnosis is vital for effective management of vertebral Aspergillus osteomyelitis.
  • Prompt medical and surgical intervention can lead to good recovery with minimal sequelae.
  • This case emphasizes the importance of considering rare fungal infections in the differential diagnosis of spinal infections, even in seemingly stable patients.

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