Journal of Orthopedics & Rheumatology
Case Report
A Rare Case of Aspergillus Spondylodiscitis In B-Cell Acute Lymphoid Leukemia
Sachin SJ1*, Smruthy AM2, Goutham KJ2, Shalaka2, Anjali Matani1, Priyank Tripati2, Nishit1, Amey CP1 and Chintankumar HK3
1Consultant haematology & Stem cell transplant, HCG Cancer
Hospital, Bangalore, India
2Clinical Pharmacology, HCG Cancer Hospital, Bangalore, India
3Department of Infectious disease, HCG Cancer Hospital, Bangalore,
India
*Address for Correspondence:
Sachin SJ, Consultant haematology & Stem cell transplant, HCG Cancer
Hospital, Bangalore, India; Phone: +91-9741351357; E-mail: drsachin.
jadhav@hcgel.com
Submission: 11 November 2021;
Accepted: 15 December 2021;
Published: 20 December 2021
Copyright: © 2021 Sachin SJ, et al. This is an open access article
distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Abstract
Introduction: Spondylodiscitis is an infection of the disc space
and surrounding vertebrae. Mycobacterium tuberculosis and
bacterial infections are the most prevalent causes, but fungal
spondylodiscitis is comparatively uncommon. Mycotic infections
are most commonly caused by Candida and Aspergillus species.
Aspergillus is a saprophytic fungus that lives mostly in soil and plants.
The incidence of Aspergillus affecting the bone among all cases of
invasive aspergillosis is estimated to be 3%. They infiltrate the spine in
immunocompromised patients, such as those who have had an organ
transplant, are on chronic steroid medication, or are undergoing
chemotherapy.
Case Report: An adult malewith Type 2 Diabetes Mellitus,
Hypertension and alcoholic liver disease was diagnosed with B-Cell
Acute Lymphoblastic Leukemia with CALLA positive, FISH Negative. He
was started on chemotherapy with G-MALL 07/03 regimen. During BFM
76/79 Re-intensification phase II the patient complained severe lower
back pain. A CT guided biopsy from the area previously diagnosed
to have Discitis (T4-T5 disc bulge soft tissue) showed negative for
malignancy. In view of persistent backache, MRI of whole spine and
pelvis was done, which revealed L4-L5 disc inflammation of infectious
etiology. Surgery for L4-L5 stabilization and biopsy from the same
region analyzed with molecular PCR revealed Aspergillus spp. Patient
was initiated on Anti-fungal agents.
Conclusion: Invasive aspergillosis most commonly affects the
sinopulmonary tract, with the lung being the most common location
of infection, while Aspergillus osteomyelitis is rare. Contiguity,
hematogenous spread, and direct implantation are all factors that
affect bone tissues. The prevalence of Aspergillus disrupting the bone
is believed to be 3% of all cases of invasive aspergillosis, with rates
ranging from 1 in 10,000 to 1 in 250,000. Treatment outcomes are greatly
influenced by a variety of factors, including neurological illnesses,
underlying conditions, and early detection and management.