Dados do Trabalho

Título

Mediastinal and vertebral Aspergillosis in immunocompetent host – rare imaging findings

Introdução

Aspergillosis is a fungal infection and invasive presentation usually involves the lungs, and in the angioinvasive form, it can disseminate beyond the respiratory tract to multiple different organs. Vertebral aspergillosis in immunocompetent hosts is rare. Most are acquired hematogenously, although it may occur following a spinal procedure.
Although rare, vertebral osteomyelitis can be a serious complication of pulmonary aspergillosis, either by direct extension or hematogenous spread from a pulmonary focus.

Descrição

In April 2021, a 58 year-old male presented to our hospital with history of precordial pain and was indicated to perform a myocardial revascularization surgery. The patient had no history of other previous conditions or immunologic diseases. A pre-operative Chest computed tomography (CT) was performed and revealed a mass in the azygo-esophageal recess associated with multiple small nodules with perilymphatic distribution.
Percutaneous biopsy of mass in the azygo-esophageal recess was performed and material collected sent to culture yielded Aspergillus fumigatus. Once the diagnosis of systemic aspergillosis was made, the patient was treated with oral voriconazole and discharged from hospital. A few weeks later the patient was readmitted to our emergency department reporting severe acute low back pain. New imaging evaluation revealed spondylodiscitis from D9-D10 disc levels complicated with adjacent epidural abscess.
A new biopsy was performed and filamentous mycelium was observed within 72 hours. Treatment protocol was promptly started with intravenous medication. After treatment and immobilization, the patient improved from his back pain and he was discharged from hospital once more. At the 3 months follow-up visit imaging findings revealed overall improvement, with no longer signs of active inflammatory process.

Discussão

Although rare, invasive and extrapulmonary aspergillosis may occur in immunocompetent hosts. Vertebral aspergillosis may result in painful conditions with neurological symptoms, and deformities. Therefore, radiologists should be familiar with imaging findings of the different forms of extrapulmonary Aspergillosis, including vertebral disease, in order to suspect and diagnose the disease at an early stage.

Palavras Chave

Vertebral aspergillosis; Osteomyelitis; Spondylodiscitis; Infection; Mediastinal mass