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.