Osteomyelitis of the rib cage by Aspergillus flavus
María Fernanda Landaburu1, Gabriela López Daneri2, Federico Ploszaj2
1Centro de Micología, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Sanatorio Municipal Dr. Julio Méndez, Buenos Aires, Argentina.
Background:
Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis.
Case Report:
A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of β-tubulin gene. Aspergillus flavus was identified.
Conclusions:
Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy.
Insights
This case report details a rare instance of Aspergillus osteomyelitis affecting the ribs in a 61-year-old female. Early diagnosis using FDG-PET/CT and targeted antifungal therapy led to successful treatment and recovery.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Radiology
Background:
- Rib osteomyelitis caused by Aspergillus is a rare and severe invasive aspergillosis.
- This condition can be debilitating, requiring prompt diagnosis and treatment.
Observation:
- A 61-year-old female presented with chest pain and a soft-tissue mass.
- FDG-PET/CT imaging revealed significant activity at the infected rib site.
- Microbiological analysis identified Aspergillus flavus from purulent material.
Findings:
- Antifungal treatment with voriconazole was initiated.
- The patient experienced lesion healing and showed no recurrence at 8-month follow-up.
- Molecular identification confirmed Aspergillus flavus through PCR and gene sequencing.
Implications:
- Microbiological studies are crucial for diagnosing osteomyelitis with soft tissue involvement.
- FDG-PET/CT is a valuable tool for assessing disease extent and treatment response in invasive aspergillosis.
- This case underscores the importance of a multidisciplinary approach in managing rare fungal infections.
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