Spinal Aspergillosis: Case Report

To describe the diagnostic challenges, clinical course, and multidisciplinary management of an invasive spinal Aspergillus fumigatus infection in a patient presenting with acute neurological deterioration.

A 42-year-old woman with poorly controlled type 1 diabetes presented with progressive neck and arm pain, followed by acute paraparesis and urinary dysfunction. Imaging revealed an apical lung mass invading the T1 to T3 vertebrae with severe spinal cord compression. She underwent urgent decompressive laminectomy and biopsy, followed by antifungal therapy with voriconazole once A fumigatus was identified. Recurrent neurological decline and persistent abscess formation prompted multiple reoperations, including costotransversectomy, abscess evacuation, and ultimately radical anterior-posterior spinal reconstruction performed by a multidisciplinary team.

Initial decompression resulted in partial neurological improvement, but recurrent abscess formation and tuberculosis infection complicated the course. Additionally, voriconazole-induced hepatotoxicity required temporary antifungal treatment discontinuation, leading to further neurological decline. Definitive management involved extensive surgical debridement, C4 to T7 posterior fixation, and C7 to T4 corpectomies with anterior reconstruction. Intraoperative cultures repeatedly confirmed A fumigatus. Over 9 months of follow-up, the patient remained free of recurrent infection. However, neurological recovery plateaued despite stable structural reconstruction.

This case highlights the complexity of managing invasive spinal aspergillosis, particularly in immunocompromised patients. Early recognition, prolonged antifungal therapy, and timely surgical intervention are critical, but radical multidisciplinary surgery may be required to achieve infection control. Neurological recovery remains limited despite successful eradication of infection.