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Myelopathy resulting from invasive aspergillosis
1Division of Neurology, Children's Hospital Los Angeles, University of Southern California, USA.
Abstract:
Aspergillus, a ubiquitous mold, may cause invasive and fatal disease in immunosuppressed patients. Myelopathy is an uncommon presentation of invasive aspergillosis. This report describes three children admitted to the hospital between 1988 and 1995 who developed myelopathy as the first evidence of invasive aspergillosis. All had advanced leukemia and were profoundly immunosuppressed because of chemotherapy and broad-spectrum antibiotics. Weakness and pain presented first; then, sensation to pain and temperature was lost 2 to 6 days later, followed by complete myelopathy. Multiple brain lesions were seen on magnetic resonance imaging in one patient. Despite antifungal therapy, aspergillosis proved fatal within 1 month of onset of myelopathy in all patients. Physicians caring for immunocompromised children should be aware of myelopathy as a presentation of invasive aspergillosis.
Insights
Invasive aspergillosis can present as myelopathy, a rare spinal cord condition, in severely immunocompromised children with leukemia. This fatal condition requires prompt physician awareness for early diagnosis and intervention.
Area of Science:
- Medical Mycology
- Pediatric Oncology
- Neurology
Background:
- Invasive aspergillosis is a severe fungal infection primarily affecting immunocompromised individuals.
- Myelopathy, a spinal cord dysfunction, is an infrequent manifestation of invasive aspergillosis.
Observation:
- This case series details three pediatric patients with advanced leukemia who presented with myelopathy as the initial sign of invasive aspergillosis.
- Patients experienced progressive neurological deficits, including weakness, pain, and loss of sensation, culminating in complete myelopathy.
- Magnetic resonance imaging revealed multiple brain lesions in one patient, indicating disseminated disease.
Findings:
- All three patients, profoundly immunosuppressed due to chemotherapy and antibiotics, succumbed to invasive aspergillosis within one month of myelopathy onset.
- Despite administration of antifungal therapies, the disease progression was rapid and uniformly fatal.
Implications:
- Healthcare providers managing immunocompromised children must consider invasive aspergillosis presenting as myelopathy.
- Early recognition of this rare neurological complication is crucial for timely diagnosis and management of invasive aspergillosis in pediatric patients.