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LETTER TO EDITOR
Year : 2007  |  Volume : 55  |  Issue : 3  |  Page : 308-309

Disseminated aspergillosis causing spinal cord compression in a child


Department of Child Health, Royal Hospital, PO 1331, Muscat, Oman

Date of Acceptance07-Aug-2007

Correspondence Address:
Riaz Ahmed
Department of Child Health, Royal Hospital, PO 1331, Muscat
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.35696

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How to cite this article:
Ahmed R. Disseminated aspergillosis causing spinal cord compression in a child. Neurol India 2007;55:308-9

How to cite this URL:
Ahmed R. Disseminated aspergillosis causing spinal cord compression in a child. Neurol India [serial online] 2007 [cited 2023 Jan 28];55:308-9. Available from: https://www.neurologyindia.com/text.asp?2007/55/3/308/35696


Sir,

Aspergillosis is a ubiquitous mold and refers to a group of diseases caused by monomorphic mycelial fungi of the genus Aspergillosis fumigatus . [1] Outbreaks of invasive aspergillosis are a problem in immunocompromised children after they are exposed to air-borne spores. [2] Central nervous system (CNS) aspergillosis is rare and a uniformly fatal complication of disseminated disease, involving the cerebral hemispheres and cerebellum, in the majority of cases. [3] Aspergillosis causing spinal cord compression due to epidural abscess formation and hypertrophic pachy-meningitis is a rare entity; [4] we present such a case in a young boy.

An eight-year-old boy was diagnosed in early infancy as chronic granulomatous disease when he had presented with recurrent abscess formation of lymph nodes and pneumonias; he was on regular daily trimethoprim-sulphamethaxazole prophylaxis. At six years of age, he developed osteomyelitis of the right 10 th rib which was resected and the necrotic material grew Aspergillosis fumigatus . He was treated with amphotericin infusion for three weeks followed by itraconazole for a month. Two years later, he developed progressive weakness of both legs with difficulty in walking.

Clinical examination revealed that he had spastic paraperesis at a D10 spinal level with spinal tenderness at D7-D9. There was no obvious swelling in the paraspinal region at that time. The bladder and bowel functions were intact although he had little hesitancy of micturation. The MRI of the thoracic spine revealed paravertebral soft tissue density in the lower dorsal region D6-D8 with liquefaction in the centre consistent with abscess [Figure - 1]. There was also moth-eaten appearance and destruction of D7 vertebral body. Orthopedician was consulted, the abscess was drained followed by laminectomy of D6 to D11 vertebrae and decompression was done. The abscess material grew Aspergillosis fumigatus . He was started on high-dose amphotericin B (1.5 mg/Kg/day IV infusion) for 30 days. Later itraconazole (4 mg/Kg-bid) was given for a month. He also received broad-spectrum antibiotics, namely imipenum, ciprofloaxacin and amikacin during the postoperative period. He developed thrombophlebitis at the injection site and later episodes of hypokalemia which were also managed by potassium supplements. He was put on plaster jacket and discharged.

On reviewing him after a month, he was paraplegic with Grade 2/5 power in legs and had urinary and bowel involvement. There was also abscess formation at the operation site with sinus, discharging pus. The wound swab grew aspergillosis; he was given a six-week course of amphotericin B and itraconazole. Bone marrow transplantation was planned but the boy developed persistent fever and the blood culture revealed Acenobacter . Despite treatment with many antibiotics, the patient died of septicemia. CNS aspergillosis primarily affects adults. It occurs as a sino-cranial infection in all the reported cases and spinal cord involvement is either due to contiguous spread from the lungs or affecting cord prior to lungs indirectly by hematogenous route. [5] Recently, there has been some increase in the incidence of invasive aspergillosis in the acquired immunocompromized individuals but the childhood disease remains a rarity. [6] Thus disseminated aspergillosis is a devastating disease in children in the immunocompromized patients and the ultimate prognosis is bad. The neurological disability was worse despite aggressive management.

 
 » References Top

1.Bennett JE. Aspergillosis Species. In: Principles and practice of infectious diseases, Mendell GL, Dolin RD, Bennett JE, editors. Vol 2. 4 th ed. Church Living Pub: 1995. p. 2306-8.  Back to cited text no. 1    
2.Neijens HJ, Frenkel J, de Muinck Keizer-Schrama SM, Dzoljic-Danilovic G, Meradji M, van Dongen JJ. Invasive Aspergillus infection in chronic granulomatous disease: Treatment with itraconazole. J Pediatr 1989;115:1016-9.  Back to cited text no. 2  [PUBMED]  
3.Walmsley S, Devi S, King S, Schneider R, Richardson S, Ford-Jones L. Invasive Aspergillus infections in a pediatric hospital: A ten-year review. Pediatr Infect Dis J 1993;12:673-82.  Back to cited text no. 3  [PUBMED]  
4.Digman KE, Partington CR, Graves VB. MR imaging of spinal pachymeningitis. J Comput Assis Tomogr 1990;14:988-90.  Back to cited text no. 4    
5.Nakazato I, Kamada Y, Taira T. Massive spinal cord necrosis associated with adult T-cell leukemia by Aspergellosis. Virchow Arch A Pathol Anat Histopathol 1993;423:397-400.  Back to cited text no. 5    
6.Klenschmidt-DeMasters BK. Central nervous system aspergillosis: A 20 yr retrospective series. Hum Pathol 2002;33:116-24.  Back to cited text no. 6    


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