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Epidural abscess, vertebral destruction, and paraplegia caused by extending infection from an aspergilloma
Abstract:
An aspergilloma developed in a lung cyst in a 53-year-old man. Aspergillus infection then contiguously spread to the epidural space, causing an abscess, vertebral destruction, and paraplegia at the level of T4. Chronic alcoholism, liver cirrhosis, and corticosteroid treatment may have been predisposing factors in this patient. Although Aspergillus epidural abscess has been described infrequently, this complication has not been described in association with an aspergilloma. Symptoms, signs, or roentgenographic or laboratory findings suggestive of vertebral or meningeal pathologic lesions in patients with aspergilloma should alert the physician to the possibility of contiguous spread of infection.
Insights
A rare case of Aspergillus epidural abscess developed from a lung aspergilloma, leading to vertebral destruction and paraplegia. This highlights the risk of contiguous spread in immunocompromised patients.
Area of Science:
- Medical Mycology
- Neurology
- Infectious Diseases
Background:
- Aspergillus infections can cause invasive disease in immunocompromised individuals.
- Epidural abscesses are a rare but serious complication of fungal infections.
- Aspergilloma, a fungal ball, typically occurs in pre-existing lung cavities.
Observation:
- A 53-year-old man with a history of chronic alcoholism, liver cirrhosis, and corticosteroid use developed an aspergilloma within a lung cyst.
- The Aspergillus infection spread contiguously from the lung to the epidural space.
- This contiguous spread resulted in an epidural abscess, destruction of the T4 vertebra, and subsequent paraplegia.
Findings:
- This case represents the first documented instance of an Aspergillus epidural abscess arising secondary to an aspergilloma.
- The patient's predisposing factors (alcoholism, cirrhosis, corticosteroid use) likely contributed to the invasive nature of the infection.
- The contiguous spread from a pulmonary focus to the central nervous system is a critical pathway for such infections.
Implications:
- Physicians should maintain a high index of suspicion for contiguous spread in patients with aspergilloma, especially if neurological symptoms arise.
- Early recognition and prompt treatment are crucial to prevent devastating neurological deficits.
- This case expands the known spectrum of invasive Aspergillus disease and its potential complications.