Aspergillus terreus Spondylodiscitis in an Immunocompromised Child

Area of Science:

• Mycology
• Infectious Diseases
• Clinical Case Study

Background:

• Invasive Aspergillosis is a serious concern in immunocompromised individuals.
• While pulmonary Aspergillosis is common, Aspergillus osteomyelitis, particularly vertebral involvement, represents a severe manifestation.
• Aspergillus fumigatus is the predominant cause of Aspergillus osteomyelitis, unlike the rarer Aspergillus terreus.

Observation:

• A 12-year-old immunocompromised boy presented with spondylodiscitis affecting the thoracolumbar spine.
• Diagnosis was confirmed via blood culture of aspiration fluid, identifying Aspergillus terreus.
• The patient exhibited noncompliance, necessitating extended voriconazole therapy with close monitoring.

Findings:

• Aspergillus terreus, a less common pathogen, was identified as the causative agent of vertebral osteomyelitis.
• Extended voriconazole therapy (23 months) with serum drug monitoring and direct observation was administered.
• This case highlights a rare instance of A. terreus causing thoracolumbar spondylodiscitis in an immunocompromised pediatric patient.

Implications:

• This case underscores the importance of considering rare Aspergillus species in immunocompromised patients with osteomyelitis.
• Effective management requires prolonged antifungal therapy, vigilant drug concentration monitoring, and adherence support.
• Further research into Aspergillus terreus osteomyelitis is warranted, especially regarding treatment protocols in pediatric populations.