CC BY
10
d.g. NAUMOV ET AL., 2023
y
spinal aspergillosis: a rare clinical case and review of the literature
D.G. Naumov12, A.A. Vishnevsky1, A.A. Karpushin1, M.M. Shchelkunov1, S.G. Tkach1
1St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russia 2St. Petersburg State University, St. Petersburg, Russia
Objective. To analyze long-term results of treatment of a patient with recurrent lumbar aspergillosis and to systematize the literature data. Material and Methods. Long-term follow-up results of treatment of recurrent Aspergillus spondylitis in a 48-year-old patient who underwent primary surgery for reconstruction of the anterior spinal column through the anterior approach were studied. Literature data on the treatment of spinal aspergillosis from 2000 to 2022 were systematized.
Results. The key method for the etiological verification of spinal aspergillosis is percutaneous bone biopsy from the lesion, followed by histological and bacteriological examination of the material. Isolated anterior spinal column reconstruction through the anterior approach ensures the achievement of local control of the infection process, but a short course of antimycotic chemotherapy after surgery is a factor of disease recurrence. The optimal duration of antimycotic chemotherapy in the postoperative period is at least 3 months, with voriconazole being the drug of choice.
Conclusion. Spondylitis caused by Aspergillus spp. is a special form of inflammatory spine disease requiring obligatory percutaneous bone biopsy for etiological verification. A multidisciplinary therapeutic approach including a course of conservative antimycotic therapy for at least 3 months, surgical debridement and reconstruction of the affected spinal motion segments provide the best clinical results. Key Words: infectious spondylitis, spinal aspergillosis, differential diagnosis, voriconazole, revision surgery.
Please cite this paper as: Naumov DG, Vishnevsky AA, Karpushin AA, Shchelkunov MM, Tkach SG. Spinal aspergillosis: a rare clinical case and a review of the literature. Hir. Pozvonoc. 2023;20(2):65—72. In Russian. DOI: http://dx.doi.org/10.14531/ss2023.2.65-72.
Spinal aspergillosis is one of the rarest infectious lesions of the vertebral column associated with certain species of mold fungi of the genus Aspergillus spp. [1, 2]. Meanwhile, the lung is the main target organ in the overall structure of aspergillus lesions, with a frequency of involvement with the pathological process of 85-90 [3]. Keratitis, endophthalmitis, osteoarthritis, and tumor-like lesions in the sinuses of the skull and nose are less frequent [4-6]. Annually, up to 200 thousand cases of invasive aspergillosis are recorded in the world; moreover, spinal lesions account for no more than 0.5-1.6 [7].
The risk group for the progression of the disease consists of workers on livestock and poultry farms, as well as patients with chronic obstruction lung diseases and autoimmune pathology [8]. Mycotic lesions have become more common in the past decade due to increase of number of immunocompromised people with HIV infection and the ones
who use immunosuppressants for organ transplantation [9-10]. After transplantation, pulmonary aspergillosis develops in every fifth recipient, and more than half of them are fatal [11]. Mycotic lesions of the bone and joint system are extremely rare and amount to 1-2 [1214]. Approximately half of these cases are spinal lesions [15-18]. Among the etiological forms of spinal aspergillosis, the main place is taken by fungi of the genus Aspergillus fumiga-tus; A. nidulans and A. flavus are less common [19-21]. The rarity and variety of clinical manifestations of spinal aspergillosis call for the systematization of existing data in terms of diagnosis and of conservative and surgical treatment.
The objective is to analyze long-term results of treatment of a patient with recurrent lumbar aspergillosis and to systematize the literature data on the issue.
Study design: case study corresponding to Class IV according to Burns et al. (2011).
Material and Methods
A male 48-year-old patient was admitted to a hospital in the unit of spinal surgery in February 2019. At the time of admission, he complained of chronic verte-brogenic pain syndrome in the lumbar spine with an intensity of up to 8 points according to VAS with irradiation to the left lower extremity and an increased level of loss of social functioning skills of up to 82 % according to ODI.
It is known from the hospital chart that the patient noted vertebrogenic pain syndrome for 1 year and 1 month and received courses of analgesic therapy (NSAIDs) without a stable therapeutic effect. According to CT findings of the lumbar spine, contact destruction of L2-L3 bodies, as well as pre- and paraverte-bral and epidural soft tissue components with the formation of spinal canal stenosis and compression of neural structures at the indicated level were defined
(Fig. 1).
65
In accordance with the medical and imaging data, the diagnosis of "chronic nonspecific osteomyelitis" was established, and a course of empiric antibacterial therapy was prescribed.
At the time of admission to the hospital, the duration of the therapeutic pause was 1 year and 2 months. Considering the clinical picture and the lack of data on etiological verification, the first stage was a diagnostic percutaneous bone biopsy of L3-L4 bodies, followed by bacteriological, DNA, and histological examination of the sample. Spinal aspergillosis (A fu-migatus) was verified.
The reconstructive stage of the surgery was made through a lateral retro-peritoneal approach for resection of the remains of the intervertebral disc and the L3-L4 vertebral bodies, anterolateral decompression of the spinal canal contents, and interbody fusion with a titanium block lattice with autograft (fragments of the iliac crest; Fig. 2).
During the postoperative period, the patient was given a two-month course of antimycotic chemotherapy (voricon-azole 200 mg twice a day). According to the control examination (6 months after surgery), there was a relief of vertebro-genic and radicular pain syndrome and a decrease in loss of social functioning skills to 26 % according to the ODI.
In 2 years and 6 months after the primary surgery, there was a progression of vertebral destruction at the L2-L4 level with the establishment of a fistulous tract and an elevation in vertebrogenic pain syndrome up to 6 points according to the VAS. The control radiation examination (CT) findings are illustrated in Fig. 3.
A two-stage revision surgery was performed: posterior out-of-focus instrumental fixation with a hybrid structure, removal of an interbody implant, resection of L2-L4 bodies, installation of negative pressure wound therapy (NPWT) system for lumbotomic wound healing. An anterior fusion was performed on the 14th day after the first revision surgery. The wound healed by primary intention, and the patient was discharged from the hospital on the 10 th day.
The duration of the course of antimy-cotic chemotherapy was extended to six months. The prospective follow-up was for 12 months; a recurrence-free course of spinal aspergillosis and persistent relief of vertebrogenic pain syndrome were observed (Fig. 4).
To systematize data on the treatment of spinal aspergillosis, literature sources were searched and reviewed using the following databases: eLibrary, PubMed, Clinical Key.
Search depth: from 2000 to 2022 inclusive. Keywords: "aspergillosis of the spine", "aspergillus spondylitis", "mycotic spondylitis" in Russian, and "aspergillus spondylodiscitis", "aspergillus spondyli-tis" in English.
Criteria for including articles in the analysis: 1) a design that corresponds to Burns et al. (2011) types IIB-IV; 2) a prospective follow-up of at least 2 months; 3) a clear indication of the type of diagnostic and therapeutic treatments; and 4) a description of the concurrent pathology.
At the initial stage, 47 papers were selected, 21 of which fully complied with the inclusion criteria. The description of the publications is given in the Table.
The final analysis included 32 case studies. Distribution of cases by localization: C (2/6 %), T (8/25 %), T/L (7/22 %), L (14/44 %), L/S (1/3 %). A. fumigatus
(62.5 %) holds the leading position in the etiological structure of pathogens of aspergillus spondylitis; A. flavus (12.5 %), A nidulans and A. niger (6.2 %) are less common.
Results and Discussion
At the outset of the disease, vertebrogenic pain syndrome is the most common and nonspecific clinical manifestation of spinal aspergillosis [16, 19, 32]. The primary granulomatous nature of the inflammatory process promotes the development of pronounced soft tissue components (pre- and paravertebral, and epidural abscesses), which in 10-20 % of cases is followed by neurological impairment due to compression of intracanal neural structures [12, 20]. There are no specific medical or imaging markers of the disease. Meanwhile, percutaneous bone biopsy with a puncture needle from the lesion remains the priority technique for etiological verification. The enzyme-linked immunosorbent assay (ELISA), recommended as an additional technique for serological diagnostics, does not have high sensitivity and, as an isolated diagnostic technique, does not enhance the frequency of verification of the process [3, 5].
An important clinical challenge associated with the difficulties of the differ-
f
- : # / m * , I
" £ s b ) 14 sH
a ____ c
Fig. 1
CT scan of a male 48-year-old patient before surgery: contact destruction of L2-L3 bodies, paravertebral soft tissue component, local kyphotic deformity of type IIA according to Rajasekaran (2017): a - sagittal view; b - frontal view; c - axial view
66
ential diagnosis of spinal aspergillosis is the mimicing of tuberculous spondylitis [21, 35-37]. For example, according to X-ray diagnostics, extensive soft tissue components (abscesses) in aspergil-losis of the spine (that mainly spread
paravertebrally) can be treated as manifestations of granulomatous inflammation, including tuberculous spondylitis [9, 15, 16, 34].
The shift in emphasis towards oral administration of voriconazole as anti-
mycotic chemotherapy has been noted since 2007, while the optimal treatment duration remains a crucial issue. In this regard, according to the results of the literature review, the treatment duration ranges from 2 weeks to 12 months, mean 3 months, while the recurrence-free course of the process has been achieved in all cases. The highest incidence rate of fatal outcomes was observed in patients receiving antimicrobial therapy within 4-6 weeks after surgery.
In the structure of concomitant pathology recorded in patients with spinal aspergillosis, immunodeficiency conditions predominate, associated both with immunosuppressive therapy after organ transplantation (3 cases) and primary oncohematological diseases (5 cases) [10, 15, 19, 26, 27, 29, 30, 32].
Since 2022, cases of spinal asper-gillosis on the background of systemic glucocorticoid therapy in patients with associated pneumonia, COVID-19 are described in the literature [20, 33].
There are four main approaches to surgical treatment: 1) debridement and reconstruction of the anterior column through the anterior approach (13 cases); 2) three-column reconstruction through the combined approach (8 cases); 3) debridement of the epidural space and anterior column through the posterior approach without posterior instrumental fixation (5 cases); and 4) debridement of the epidural space and anterior column through the posterior approach with posterior instrumental fixation (4 cases).
Considering the predominant involvement of the anterior column of the spine, debridement and reconstruction of the vertebrae in the vast majority of cases was performed through an isolated anterior approach that in the long-term period ensured a recurrence-free course of the mycotic process in 84.6 % of cases.
We consider that the chosen surgical approach in the presented case study corresponded to the accepted approaches. Nevertheless, the antimycotic therapy with the duration of 2 months was insufficient. It was a factor in the recurrence of spinal aspergillosis. The involvement of adjacent spinal motion segments
Fig. 2
Radiographs of the spine of a male 48-year-old patient after abscessotomy, marginal resection of L2-L3 bodies, anterior decompression of the dura mater, anterior fusion with a titanium block lattice with autologous bone: a - sagittal view; b - frontal view
v „ A ^^ f *9
/ zl fe,
v X' I ? ?
0 a l j ■ ^f b
Fig. 3
CT scan of a male 48-year-old patient after surgery: progression of destruction in the contact segments, destabilization of the titanium block lattice with autologous bone, a - sagittal view; b - frontal view
_67_
tumors and inflammatory diseases of the spine
d.g. naumov et al. spinal aspergillosis: a rare clinical case and review of the literature
■F { *SJE I^^^H
jMÈÈSÎ 4F I ! M II.' u H
¿s ML
-JH fl i
'm i
a b **.
Fig. 4
Radiographs of a male 48-year-old patient 10 months after the revision surgery: stable position of the anchor elements of the metal instrumentation, no signs of recurrence of the mycotic process: a - sagittal view; b - frontal view
requires the necessity of extension of the anterior column resection length to three segments that, in turn, requires an additional spinopelvic fixation and posterior fusion using autografts.
Conclusion
Aspergillus spp. associated spondylitis is a special form of inflammatory spinal disease requiring mandatory diagnostic percutaneous bone biopsy for etiological verification. A multidisciplinary therapeutic approach, including a course of conservative antimycotic therapy for at least 3 months, debridement, and reconstruction of the affected spinal motion segments, ensures the best clinical outcomes.
The study had no sponsors.
The authors declare that they have no conflict of
interest.
The study was approved by the local ethical
committees of institutions.
The processing of the medical history materials was
done with the patient's written consent.
All authors contributed significantly to the research
and preparation of the article, read and approved
the final version before publication.
68
Table Description of publications included in the systematic literature review
Author Number of cases Localization/ etiology Treatment strategy Outcome
Van Ooij et al. [17] 4 T1, T/L2, L1/ A. fumigatus (4) Amphotericin B 2 g per day for 2 months, reconstruction of the anterior column through the anterior approach Improvement — 2, progression of neurological deficit — 1, fatal outcome due to the primary disease — 2
Ur-Rahman et al. [21] T/A. flavus Amphotericin B 2 g per day for 6 weeks, debridement of the anterior column through the posterolateral approach + posterior instrumental fixation Fatal outcome due to the disease progression
Gupta et al. [22] T/A. niger Amphotericin B 700 mg per day + itraconazole 200 mg per day for 3 months, debridement of the anterior column through the anterior approach Fatal outcome due to the disease progression
Auletta et al.[23] T/A. flavus Amphotericin B 2 g per day + rifampicin 300 mg per day for 6 weeks, debridement of the anterior column through the anterior approach Recurrence-free course
Chi et al. [24] C/A. flavus Amphotericin B 2 g per day, debridement of the anterior column through the posterior approach Fatal outcome due to intraventricular hemorrhage complicated by mycotic meningoencephalitis
Saigal et al. [25] T/L/ A. fumigatus Percutaneous bone biopsy, amphotericin B 2 g per day, debridement of the anterior column through the posterior approach Recurrence-free course
Vaishya et al. [18] T/ A. fumigatus Amphotericin B 2 g per day, reconstruction of the anterior column through the anterior approach + posterior instrumental fixation Fatal outcome 2 months after surgery due to generalization of the process
Son et al. [26] L/A. fumigatus Reconstruction of the anterior column in the cervical spine through the anterior approach Recurrence 1 month after surgery, antimicrobial therapy regimen is not presented
Weclawiak et al. [27] T12-L1/ A. fumigatus Percutaneous bone biopsy, voriconazole 200 mg per day for 6 months Recurrence-free course
Tew et al. [28] 1 T/ A. fumigatus Voriconazole 200 mg per day for 2 weeks, debridement of the anterior column through the posterior approach Fatal outcome 2 weeks after surgery due to generalization of the process
Nicolle et al. [10] C/A. flavus Percutaneous bone biopsy, voriconazole 200 mg per day for 12 months Recurrence-free course
Raj et al. [29] L/S/ A. fumigatus Percutaneous bone biopsy, laminectomy, debridement of L5—S1 without posterior instrumental fixation, voriconazole 200 mg per day for 3 months Recurrence-free course
Shashidhar et al. [30] L/A. fumigatus Percutaneous bone biopsy, decompression + posterior instrumental fixation, voriconazole 200 mg per day for 3 months Recurrence-free course
Yoon et al. [15] L/A. fumigatus Empiric anti-tuberculosis chemotherapy for 1 month, percutaneous bone biopsy + laminectomy of L2, reconstruction of the anterior column through the anterior approach Preservation of lower paraparesis type D according to Frankel, recurrence-free course
McCaslin et al. [31] T/L/ A. fumigatus Percutaneous bone biopsy, voriconazole 6 mg per kg daily for 4 weeks, laminectomy, debridement without posterior instrumental fixation Fatal outcome 2 weeks after surgery due to generalization of the process
69
The end of the Table Description of publications included in the systematic literature review
Author Number of cases Localization/ etiology Treatment strategy Outcome
Lyons et al. [19] 1 L3- L4/ A. nidulans Percutaneous bone biopsy, voriconazole 200 mg per day for 6 weeks, 360° reconstruction through combined approach Prolongation of voriconazole 300 mg per day for 7 months, recurrence-free course for 3 years
Sohn et al. [32] L/A. terreus Percutaneous bone biopsy, voriconazole 200 mg per day for 4 weeks Recurrence 4 months after the moment of completion of the first course of chemotherapy, the resumption of chemotherapy for 9 months; recurrence-free course
Dai et al. [13] 6 T1, T/L1, L4/ A. fumigatus (2), A. niger (1) Aspergillus spp. (3) Voriconazole 200 mg per day for 4 months, debridement of the anterior column through the posterior approach + posterior instrumental fixation (5), without surgery (1) Recurrence-free course
Prayag et al. [33] 4 T/L1, L3/ Fumigatus (3), A. nidulans (1) Percutaneous bone biopsy, reconstruction of the anterior column from the anterior approach (L), decompression + posterior instrumental fixation (T/L), voriconazole 200 mg per day for 3 weeks Recurrence-free course
Rashid et al. [34] T/ A. fumigatus Empiric anti-tuberculosis chemotherapy for 1 month, percutaneous bone biopsy, decompression + posterior instrumental fixation, voriconazole 200 mg per day for 3 months. No clinical effect of empiric anti-tuberculosis chemotherapy, recurrence-free course after surgery and a course of antimicrobial therapy
Keerthi et al. [20] L/A. fumigatus Percutaneous bone biopsy, voriconazole 200 mg per day for 3 months Recurrence-free course
References
1. Cadena J, Thompson GR 3rd, Patterson TF. Aspergillosis: epidemiology, diagnosis, and treatment. Infect Dis Clin N Am. 2021;35:415-434. DOI: 10.1016/j.idc.2021.03.008.
2. Gautier M, Normand AC, Ranque S. Previously unknown species of Aspergillus. Clin Microbiol Infect. 2016;22:662-669. DOI: 10.1016/j.cmi.2016.05.013.
3. Gamaletsou MN, Rammaert B, Bueno MA, Sipsas NV, Moriyama B, Kontoyian-nis DP, Roilides E, Zeller V, Taj-Aldeen SJ, Henry M, Petraitis V, Denning DW, Lortholary O, Walsh TJ. Aspergillus arthritis: Analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases. Med Mycol. 2017;55:246-254. DOI: 10.1093/ mmy/myw077.
4. Ordaya EE, Johnson JR, Drekonja DM, Niehans GE, Kaka AS. Aspergillus osteomyelitis secondary to chronic necrotizing pulmonary Aspergillosis in a patient with rheumatoid arthritis. Cureus. 2021;13.e17774. DOI: 10.7759/cureus.17774.
5. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pap-pas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Munoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and
70
the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/ MSG) Consensus Group. Clin Infect Dis. 2008;46:1813-1821. DOI: 10.1086/588660.
6. Attaway AH, Jacono F, Gilkeson R, Faress JA. Subacute invasive pulmonary aspergillosis associated with ankylosing spondylitis. Am J Respir Crit Care Med. 2016;193:572-573. DOI: 10.1164/rccm.201507-1476IM.
7. Senosain-Leon V, Hidalgo-Benites A, Arriola-Montenegro J, D'Angelo-Piag-gio L, Beas R. Invasive pulmonary aspergillosis with Aspergillus vertebral osteomyelitis in an HIV-infected adult: a case report. Int J STD AIDS. 2019;30:1140-1142. DOI: 10.1177/0956462419865403.
8. Gamaletsou MN, Rammaert B, Bueno MA, Moriyama B, Sipsas NV, Kontoyi-annis DP, Roilides E, Zeller V, Prinapori R, Taj-Aldeen SJ, Brause B, Lortholary O, Walsh TJ. Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome. J Infect. 2014;68:478-493. DOI: 10.1016/j.jinf.2013.12.008.
9. Khalid M, Ali SA. Fungal osteomyelitis in a patient with chronic granulomatous disease: Case report and review of the literature. J Pak Med Assoc. 2018;68:1387-1390.
10. Nicolle A, de la Blanchardiere A, Bonhomme J, Hamon M, Leclercq R, Hiti-er M. Aspergillus vertebral osteomyelitis in immunocompetent subjects: case report and review of the literature. Infection. 2013;41:833-840. DOI: 10.1007/s15010-013-0463-6.
11. Jiang Z, Wang Y, Jiang Y, Xu Y, Meng B. Vertebral osteomyelitis and epidural abscess due to Aspergillus nidulans resulting in spinal cord compression: case report and literature review. J Int Med Res. 2013;41:502-510. DOI: 10.1177/0300060513476432.
12. Koutserimpas C, Chamakioti I, Naoum S, Raptis K, Alpantaki K, Kofteri-dis DP, Samonis G. Spondylodiscitis caused by aspergillus species. Diagnostics (Basel). 2021;11:1899. DOI: 10.3390/diagnostics11101899.
13. Dai G, Wang T, Yin C, Sun Y, Xu D, Wang Z, Luan L, Hou J, Li S. Aspergillus spondylitis: case series and literature review. BMC Musculoskelet Disord. 2020;21:572. DOI: 10.1186/s12891-020-03582-x.
14. Simeone FJ, Husseini JS, Yeh KJ, Lozano-Calderon S, Nelson SB, Chang CY. MRI and clinical features of acute fungal discitis/osteomyelitis. Eur Radiol. 2020;30:2253-2260. DOI: 10.1007/s00330-019-06603-z.
15. Yoon KW, Kim YJ. Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult. Br J Neurosurg. 2015;29:277-279. DOI: 10.3109/02688697.2014.957648.
16. Dotis J, Roilides E. Osteomyelitis due to Aspergillus spp. in patients with chronic granulomatous disease: comparison of Aspergillus nidulans and Aspergillus fumigatus. Int J Infect Dis. 2004;8:103-110. DOI: 10.1016/j.ijid.2003.06.001.
17. van Ooij A, Beckers JM, Herpers MJ, Walenkamp GH. Surgical treatment of aspergillus spondylodiscitis. Eur Spine J. 2000;9:75-79. DOI: 10.1007/s005860050014.
18. Vaishya S, Sharma MS. Spinal Aspergillus vertebral osteomyelitis with extra-dural abscess: case report and review of literature. Surg Neurol. 2004;61:551-555. DOI: 10.1016/j.surneu.2003.06.005.
19. Lyons MK, Neal MT, Patel NP, Vikram HR. Progressive back pain due to Aspergillus nidulans vertebral osteomyelitis in an immunocompetent patient: surgical and antifun-gal management. Case Rep Orthop. 2019;2019:4268468. DOI: 10.1155/2019/4268468.
20. Keerthi CI, Bhat S, Mulki SS, Bhat KA. Fungal infections of spine: Case series during the COVID times. Indian J Med Microbiol. 2022;40:605-607. DOI: 10.1016/j. ijmmb.2022.07.002.
21. Ur-Rahman N, Jamjoom ZA, Jamjoom A. Spinal aspergillosis in nonimmuno-compromised host mimicking Pott's paraplegia. Neurosurg Rev. 2000;23:107-111. DOI: 10.1007/pl00021703.
22. Gupta PK, Mahapatra AK, Gaind R, Bhandari S, Musa MM, Lad SD. Aspergillus spinal epidural abscess. Pediatr Neurosurg. 2001;35:18-23. DOI: 10.1159/000050380.
23. Auletta JJ, John CC. Spinal epidural abscesses in children: A 15-year experience and review of the literature. Clin Infect Dis. 2001;32:9-16. DOI: 10.1086/317527.
24. Chi CY, Fung CP, Liu CY. Aspergillus flavus epidural abscess and osteomyelitis in a diabetic patient. J Microbiol Immunol Infect. 2003;36:145-148.
25. Saigal G, Donovan Post MJ, Kozic D. Thoracic intradural Aspergillus abscess formation following epidural steroid injection. AJNR Am J Neuroradiol. 2004;25:642-644.
26. Son JM, Jee WH, Jung CK, Kim SI, Ha KY. Aspergillus spondylitis involving the cer-vico-thoraco-lumbar spine in an immunocompromised patient: a case report. Korean J Radiol. 2007;8:448-451. DOI:10.3348/kjr.2007.8.5.448.
27. Weclawiak H, Garrouste C, Kamar N, Linas MD, Tall P, Dambrin C, Durand D, Rostaing L. Aspergillus fumigatus-related spondylodiscitis in a heart transplant patient successfully treated with voriconazole. Transplant Proc. 2007;39:2627-2628. DOI: 10.1016/j.transproceed.2007.08.014.
28. Tew CW, Han FC, Jureen R, Tey BH. Aspergillus vertebral osteomyelitis and epidural abscess. Singapore Med J. 2009;50:e151-e154.
29. Raj KA, Srinivasamurthy BC, Nagarajan K, Sinduja MG. A rare case of spontaneous Aspergillus spondylodiscitis with epidural abscess in a 45-year-old immunocompetent female. J Craniovertebr Junction Spine. 2013;4:82-84. DOI: 10.4103/0974-8237.128538.
30. Shashidhar N, Tripathy SK, Balasubramanian S, Dhanakodi N, Venkataram-aiah S. Aspergillus spondylodiscitis in an immunocompetent patient following spinal anesthesia. Orthop Surg. 2014;6:72-77. DOI: 10.1111/os.12091.
31. McCaslin AF, Lall RR, Wong AP, Lall RR, Sugrue PA, Koski TR. Thoracic spinal cord intramedullary aspergillus invasion and abscess. J Clin Neurosci. 2015;22:404-406. DOI: 10.1016/j.jocn.2014.04.030.
32. Sohn YJ, Yun JH, Yun KW, Kang HJ, Choi EH, Shin HY, Lee HJ. Aspergillus ter-reus spondylodiscitis in an immunocompromised child. Pediatr Infect Dis J. 2019;38: 161-163. DOI:10.1097/INF.0000000000002125.
33. Prayag PS, Purandare BD, Patwardhan SA, Pairaiturkar PP, Rege AJ, Bhave AV, S R, Panchakshari SP, Raja PT, Melinkeri AS, Prayag AP. COVID-19 associated vertebral osteomyelitis caused by aspergillus species - a case series. Indian J Orthop. 2022;56:1268-1276. DOI: 10.1007/s43465-022-00633-4.
34. Rashid MH, Hossain MN, Ahmed N, Kazi R, Ferini G, Palmisciano P, Sca-lia G, Umana GE, Hoz SS, Chaurasia B. Aspergillus spinal epidural abscess: A case report and review of the literature. J Craniovertebr Junction Spine. 2022;13:204-211. DOI: 10.4103/jcvjs.jcvjs_35_22.
35. Mushkin AYu, Vishnevsky AA. Clinical recommendations for the diagnosis of infectious spondylitis. Project for discussion. Medical Alliance. 2018;(3):65-74.
36. Chernopyatova RM, Blinov NP, Mitrofanov VS. Aspergillus infection; approaches to its diagnosis and treatment. Problems in Medical Mycology. 2002; 4(1): 4-16.
37. Vishnevskii A, Naumov D, Makogonova M, Oleynik V. Tuberculous spinal epi-dural abscess (case report and literature review). Medical Alliance. 2020;8(2):57-63. DOI: 10.36422/23076348-2020-8-2-57-63.
Address correspondence to:
Naumov Denis Georgyevich
St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky pr., St. Petersburg, 191036, Russia, dg.naumov@spbniif.ru
Received 28.03.2023
Review completed28.04.2023
Passed for printing 04.05.2023
71
d.g. NAUMOV ET al. spinal aspergillosis: a rare clinical case and review of the literature
Denis Georgyevich Naumov, MD, PhD, leading researcher, head of research laboratory of spine pathology, head of Spine Surgery Department No. 6, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky pr., St. Petersburg, 191036, Russia; Assistant professor of the Department of General Surgery, St. Petersburg State University, 7/9 Universitetskaya embankment, St. Petersburg, 199034, Russia, ORCID: 0000-0002-9892-6260, dg.naumov@spbniif.ru; Arkady Anatolyevich Vishnevsky, DMSc, leading researcher, research laboratory of spinal pathology, neurosurgeon of Spine Surgery Department No. 6, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky pr., St. Petersburg, 191036, Russia, ORCID: 0000-0002-9186-6461, vichnevsky@mail.ru; Andrey Andreyevich Karpushin, MD, intern-researcher at the research laboratory of spinal pathology, orthopedic traumatologist of Spine Surgery Department No. 6, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky pr., St. Petersburg, 191036, Russia, ORCID: 0000-0002-7178-3861, karpushin@lyag.ru; Mikhail Mikhailovich Shchelkunov, junior researcher, research laboratory of spinal pathology, orthopedic traumatologist of Spine Surgery Department No. 6, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky pr., St. Petersburg, 191036, Russia, ORCID: 0000-0002-6305-6023, mm.shelkunov1881@yandex.ru; Sergey Gennadyevich Tkach, junior researcher, research laboratory of spinal pathology, orthopedic traumatologist of Spine Surgery Department No. 6, St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovsky pr., St. Petersburg, 191036, Russia, ORCID: 0000-0001-7135-7312, sg.tkatch@spbniif.ru.
72
