Related Experiment Videos
Massive spinal cord necrosis associated with adult T-cell leukaemia caused by Aspergillus
I Nakazato1, Y Kamada, T Taira
1Department of Pathology, Ryukyu University School of Medicine, Okinawa, Japan.
Abstract:
A man with adult T-cell leukaemia (ATL) underwent massive spinal cord necrosis caused by Aspergillus infection. Leukopenia due to anti-cancer chemotherapy resulted in pulmonary Aspergillus infection. The aspergilloma was reduced in size by anti-fungal chemotherapy, but paraplegia occurred. At autopsy, the pulmonary aspergilloma was encapsulated and showed no contiguous extension of the infection to the epidural or subdural spaces or spinal cord. However, at the T5 level of the spinal cord, there was marked necrosis with haemorrhage caused by Aspergillus infection, but without leukaemic cell infiltration of the spinal cord. Dichotomously branching Aspergillus hyphae filled the blood vessels of the T5 level of the spinal cord.
Insights
A man with adult T-cell leukaemia developed Aspergillus spinal cord necrosis due to chemotherapy-induced leukopenia. Autopsy revealed Aspergillus hyphae in spinal blood vessels, causing necrosis without direct extension or leukemic infiltration.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Adult T-cell leukaemia (ATL) treatment can cause immunosuppression, increasing opportunistic infections.
- Chemotherapy-induced leukopenia heightens the risk of invasive fungal infections like aspergillosis.
Observation:
- A patient with ATL developed pulmonary aspergillosis secondary to chemotherapy-induced leukopenia.
- Despite antifungal treatment, the patient experienced paraplegia.
- Autopsy revealed extensive spinal cord necrosis at T5, attributed to Aspergillus infection.
Findings:
- Aspergillus infection caused massive spinal cord necrosis and hemorrhage at the T5 level.
- The spinal cord infection was characterized by Aspergillus hyphae within blood vessels, not direct extension from pulmonary aspergilloma.
- No leukemic cell infiltration was observed in the affected spinal cord tissue.
Implications:
- This case highlights a rare but severe neurological complication of invasive aspergillosis in immunocompromised patients.
- Fungal infections can lead to significant neurological deficits through vascular dissemination, even without direct tissue invasion.
- Understanding mechanisms of fungal neuroinvasion is crucial for managing opportunistic infections in cancer patients.