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Published on: May 23, 2021
Primary Aspergillus spondylodiscitis in a liver transplant recipient
Xin-Feng Li1, Zu-de Liu, Qiang Xia
1Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Abstract:
Solid organ transplant recipients are at increased risk for Aspergillus infections. However, the cases of Aspergillus spondylodiscitis are rare and mostly resulted from the hematogenous spread of invasive pulmonary Aspergillosis. Here, we report a case of primary spondylodiscitis in a liver transplant recipient. Six months after transplantation, a chronic and progressive lumbar back pain was presented. The patient had no fever and the white blood cell count was normal. High plasma (1→3)-beta-d-glucan (BDG) level was detected at the time of back pain. The pathogen was Aspergillus flavus. Clinical and radiological healing was achieved through posterior only debridement and voriconazole therapy.
Insights
Primary Aspergillus flavus spondylodiscitis is a rare complication in liver transplant recipients. This case highlights successful treatment with debridement and voriconazole, even without fever or elevated white blood cell count.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Mycology
Background:
- Solid organ transplant recipients face heightened risks of Aspergillus infections.
- Aspergillus spondylodiscitis is uncommon, typically arising from invasive pulmonary disease spread.
- Primary spinal infection without pulmonary involvement is exceptionally rare.
Observation:
- A liver transplant recipient presented with chronic lumbar back pain six months post-transplant.
- The patient lacked fever and had normal white blood cell counts.
- Elevated plasma (1→3)-beta-d-glucan (BDG) levels correlated with back pain.
Findings:
- The causative agent was identified as Aspergillus flavus.
- The infection was diagnosed as primary spondylodiscitis.
- Clinical and radiological recovery was achieved.
Implications:
- This case demonstrates that Aspergillus spondylodiscitis can occur primarily in the spine in transplant patients.
- Prompt diagnosis using markers like BDG is crucial.
- Effective treatment involves surgical debridement and antifungal therapy (voriconazole).
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