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Age / Sex : /
Age/Sex : 46/M
C.C.: Back pain
1) What is your impression?
Courtesy : Won-Hee Jee, MD Department of Radiology, Kangnam St. Mary’s Hospital, The Catholic University of Korea
Diagnosis: aspergillus spondylitis or fungal spondylitis
Discussion
Findings:
MR imaging of lumbar spine shows band-like or diffuse hypointense signal in the vertebral bodies at L2-L5 on T1-weighted image. It is isointense to slightly hyperintense on T2-weighted image. Some hypointense signals and preservation of the intranuclear clefts are seen in L2-3 and L4-5 discs. Absence of disc hyperintensity and loss of intranuclear cleft are seen in L3-4 disc. Endplate irregularities are seen in involved spine. Disc space narrowing is seen in L3-4 and L4-5 levels. Band-like or diffuse enhancement is observed in involved vertebral bodies with epidural abscess on contrast enhanced T1-weighted image. Paraspinal abnormal signal is relatively well-defined. Pathological examination of the intervertebral disc reveals acute inflammation, necrosis and portions of the tissue being invaded by septate hyphae hyphae (hematoxylin-eosin staining, not shown). Branching septate hyphae are uniform in width and dispose mostly at acute angles (diastase periodic acid Schiff, ×400).
Differential Diagnosis:
1. Aspergillus spondylitis or Fungal spondylitis
2. Candida spondylitis
Diagnosis: Aspergillus spondylitis or Fungal spondylitis
Discussion:
Aspergillosis is a rare cause of spondylitis. Early diagnosis with MR imaging and adequate treatment can prevent the serious complications of fungal infection. MR findings prefers tuberculous spondylitis rather than pyogenic spondylitis: a well-defined paraspinal abnormal signal rather than an ill-defined paraspinal abnormal signal, a thin and smooth abscess wall rather than a thick and irregular abscess wall, presence of paraspinal or intraosseous abscess, subligamentous spread ³ three vertebral levels, multiple vertebral body involvement, and thoracic spine involvement. However, in this case there is no paraspinal or intraosseous abscess in spite of extensive involvement of vertebral bodies and paraspinal abnormal signal. Aspergillus spondylitis should be considered in differential diagnosis in immunocompromised patients with some MR findings mimicking tuberculous spondylitis.
References:
1. Williams RL, Fukui MB, Meltzer CC, Swarnkar A, Johnson DW, Welch W. Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. AJNR 1999;20:381-385
2. Son JM, Jee WH, Jung CK, Kim SI, Ha KY. Aspergillus Spondylitis involving Cervico-thoraco-lumbar Spine in an Immunocompromised Patient: A Case Report. KJR 2007 October
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