Vaishya Sandeep, Sharma Manish Singh
Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Surg Neurol. 2004 Jun;61(6):551-5; discussion 555. doi: 10.1016/j.surneu.2003.06.005.
Spinal extradural abscesses caused by Aspergillus species are rare and occur mostly in immunocompromised patients or in patients with Aspergillomas elsewhere in the body. In this report, the authors draw attention to a rapidly developing syndrome of extradural compressive myelopathy in an immunocompetent patient. Only four other cases have been reported previously.
A 35-year-old female presented with rapidly progressive painful paraparesis progressing to paraplegia in 15 days despite adequate empiric antitubercular therapy. Magnetic resonance imaging (MRI) revealed D11 vertebral body destruction and an extradural mass compressing the cord from D10 to D12. The patient underwent a D11 corpectomy and spinal stabilization with an iliac bone strut graft, 'Z' Plate and screw fixation. The biopsy showed fungal hyphae with dichotomous branching diagnostic of Aspergillosis. Despite treatment with Amphotericin B and oral Itraconazole the patient developed rapidly progressive multiorgan failure and expired after 2 months.
The authors report the fifth and extremely rare case of Aspergillus vertebral osteomyelitis with an extradural abscess in an immunocompetent patient. Therapy is controversial and predicated on the use of highly toxic drugs with inconsistent efficacies. Mortality remains grievously high.
曲霉菌引起的脊柱硬膜外脓肿较为罕见，主要发生于免疫功能低下患者或体内存在曲菌球的患者。在本报告中，作者关注到一名免疫功能正常的患者出现了快速进展的硬膜外压迫性脊髓病综合征。此前仅报道过另外4例。
一名35岁女性，尽管接受了充分的经验性抗结核治疗，但仍在15天内出现快速进展的疼痛性双下肢轻瘫并发展为截瘫。磁共振成像（MRI）显示第11胸椎椎体破坏，硬膜外肿块从第10胸椎至第12胸椎压迫脊髓。患者接受了第11胸椎椎体切除及髂骨支撑植骨、“Z”形钢板和螺钉固定的脊柱稳定手术。活检显示真菌菌丝呈二分分支，诊断为曲霉菌病。尽管使用了两性霉素B和口服伊曲康唑治疗，患者仍迅速出现多器官功能衰竭，并在2个月后死亡。
作者报告了第5例且极为罕见的免疫功能正常患者发生曲霉菌性椎体骨髓炎并伴有硬膜外脓肿的病例。治疗存在争议，且依赖于使用疗效不一的高毒性药物。死亡率仍然极高。
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