Citation Information :
Raju S, Muthu C, Reddy SK, Thangamani V, Jeyashankaran BK, Sambandam A. Thoracic Fungal Osteomyelitis with Compressive Myelopathy in an Immunocompetent Individual by a Rare Fusarium Species: A Case Report. 2021; 3 (2):91-94.
Background: Thoracic vertebral osteomyelitis/spondylodiscitis and spinal epidural abscess are rare but life-threatening conditions, commonly seen in immunocompromised persons. It requires early detection and prompt management, to avoid late sequelae and complications. The cause for this abscess can be pyogenic, tuberculosis, fungal, or parasitic. Candida and Aspergillus species are the most common fungal causes which mainly present as discitis or osteomyelitis in the immunocompromised patient, after hematogenous dissemination.
Case discussion: We report about Fusarium, an opportunistic human pathogen which is a normal commensal of human skin flora, in a 60-year-old healthy gentleman with no immunocompromised stage, the rare cause of thoracic vertebral osteomyelitis with epidural abscess D9 to D11 with compressive myelopathy and neurological deficit in this article.
Conclusion: Along with aerobic, anaerobic bacterial and tuberculous, microbiological and histopathological investigations should also include fungal workup. Proper fungal isolation from the tissue is a must for prompt treatment and a better outcome for the patient.
Keating P. Fungus infection of bone and joint. South Med J 1932;25(10):1072–1079. DOI: 10.1097/00007611-193210000-00016.
Kim CW, Perry A, Currier B, et al. Fungal infections of the spine. Clin Orthop Relat Res 2006;444:92–99. DOI: 10.1097/01.blo.0000203451.36522.4c.
Titlic M, Josipovic-Jelic Z. Spondylodiscitis. Bratisl Lek Listy 2008;109(8):345–347.
Tupaki-Sreepurna A, Kindo AJ. Fusarium: The versatile pathogen. Indian J Med Microbiol 2018;36(1):8–17. DOI: 10.4103/ijmm.IJMM_16_24.
Gupta AK, Baran R, Summerbell RC. Fusarium infection of the shin. Curr Opin Infect Dis 2000;13(2):121–128. DOI: 10.1097/00001432-200004000-00005.
Verner EF, Musher DM. Spinal epidural abscess. Symposium on infections of the central nervous system. Med Clin North Am 1985;69(2):375–384. DOI: 10.1016/s0025-7125(16)31049-5.
North JB, Brophy BP. Epidural abscess: a hazard of spinal epidural anaesthesis. Aust NZ J Surg 1979;49(4):484–485. DOI: 10.1111/j.1445-2197.1979.tb05847.x.
Nucci M, Anaissie E. Cutaneous infection by fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin. Infect. Dis. 2002;35(8):909–920. DOI: 10.1086/342328.
Darouiche RO, Hamill RJ, Greenberg SB, et al. Bacterial spinal epidural abscess: review of 43 cases and literature survey. Medicine 1992;71(6):369–385. DOI: 10.1097/00005792-199211000-00004.
Caldera G, Cahueque M, Cobar A, et al. Fungal spondylodiscitis: review. J Spine 2016;5(02):2. DOI: 10.4172/2165-7939.1000302.
Romano C, Caposciutti P, Ghilardi A, et al. A case of primary localised cutaneous infection due to fusarium oxysporum. Mycopathologia 2010;170(1):39–46. DOI: 10.1007/s11046-010-9290-9.
Sreedharan Namboothiri PE, Nair SN, Vijayan K, et al. Disseminated fusarium oxysporum neurospinal infection. Indian J Orthop 2014;48(2):220–222. DOI: 10.4103/0019-5413.128773.
Yang SC, Fu TS, Chen LH, et al. Identifying pathogens of spondylodiscitis: percutaneous endoscopy or CT-guided biopsy. Clin Orthop Relat Res 2008;466(12):3086–3092. DOI: 10.1007/s11999-008-0441-y.