Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-co...Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.展开更多
Background: Spondylodiscitis is a spinal infection rare affecting primarily the intervertebral disk and the adjacent vertebral bodies. His diagnosis is difficult and often delayed or missed due to the rarity of the di...Background: Spondylodiscitis is a spinal infection rare affecting primarily the intervertebral disk and the adjacent vertebral bodies. His diagnosis is difficult and often delayed or missed due to the rarity of the disease. Cervical spondylodiscitis has quite rare findings regarding the common location of spinal abscesses in the lumbar and thoracic regions. To obtain the best patient outcomes, these spinal infections require prompt diagnosis and appropriate treatment. Case description: A 44-year-old boy was admitted to the neurosurgery department of our hospital for heaviness in 4 limbs without gait disorders in context infected tracheostomy after staying in intensive care. MRI spine showed a spine deformity with lyse C4C5 epiduritis and spinal cord compressed. Antibiotics intravenous were started for 1 month the patient benefited from a corpectomy with an iliac graft and anterior cervical plate. The anatomopathological examination revealed an inflammation not specific. He was therefore put on antibiotics for 6 weeks. Three months later the neck pain and limb pain resolved after treatment and a complete return of lower extremity strength. Conclusion: Cervical spondylodiscitis has increased and become more aggressive. While radical surgical debridement, stable reconstruction together with antibiotic therapy remained a reliable approach to achieve complete healing of the inflammation, anterior alone surgery became more applicable.展开更多
Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spon...Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients＇ general information, mi- crobiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association （ASIA） im- pairment, visual analogue scale （VAS）, and Oswestry Disability Index （ODI）. Ten patients had under- gone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments in- cluded L1-2, L2-3, L3,~, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were posi- tive for Staphylococcus aureus （5 cases）, Staphylococcus epidermidis （4）, Streptococcus （3）, and Es- cherichia coli （1）. The operative time was 213.8＋45.6 min, and the intraoperative blood loss was 180.6-4-88.1 mL. Postoperative complications consisted of urinary retention （2 cases）, constipation （3）, and deep vein thrombosis （2）. On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with poste- rior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondy- lodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.展开更多
BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such...BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.展开更多
<b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> T</span><span style="font-family:Verdana;">he <...<b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> T</span><span style="font-family:Verdana;">he </span><span style="font-family:Verdana;">o</span><span style="font-family:Verdana;">bjective is to</span><span style="font-family:""><span style="font-family:Verdana;"> determine the frequency and the semiological and evolutionary profiles of infectious spondylodiscitis in hospital practice in Kara. </span><b><span style="font-family:Verdana;">Patients</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">methods:</span></b><span style="font-family:Verdana;"> This was a cross-sectional study of a case series of patients with infectious spondylodiscitis, who were admitted to the rheumatology department of Kara University Hospital in North Togo. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Among the 3972 examined patients, 86 (33 males and 53 females) patients (2.16%) had infectious spondylodiscitis. The average age of these patients at the onset of the disease was 47.20 years. The average duration of the disease was 11.41 months. Tuberculosis was suspected in 77 of 86 patients (89.53%). The infectious spondylodiscitis most often affected the lumbar (51.04%) and dorsal (21.87%) segments and was associated with a pulmonary location in 31 patients (36.04%). In addition to underdevelopment and poor hygiene (72 cases), alcoholism (15 cases) and human immunodeficiency virus infection (10 cases) were the main risk factors identified. The progress with the medical treatment was favorable in 65 patients (75.58%) and 16 patients were lost to follow-up. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The frequency of infectious spondylodiscitis reflects the underdevelopment and poor hygiene levels in Black Africa. Its etiology is most commonly associated with tuberculosis and remains a concern despite the epidemiological transition of the different diseases.展开更多
Postoperative spondylodiscitis is a rare but serious complication after lumbar disc surgery.Most cases are due to more virulent organisms such as Staphylococcus aureus and Streptococcus.No case of post operative tuber...Postoperative spondylodiscitis is a rare but serious complication after lumbar disc surgery.Most cases are due to more virulent organisms such as Staphylococcus aureus and Streptococcus.No case of post operative tubercular spondylodiscitis has been reported till date to our knowledge. We are reporting a case of tubercular spondylodiscitis followed by lumbar disc surgery of L2-3 level.展开更多
Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbid...Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.展开更多
Aim: To determine the prevalence and risk factor of infectious spondylodiscitis in children in Benin. Patients and Method: A descriptive cross-sectional study over 5 years was conducted in rheumatology and paediatric ...Aim: To determine the prevalence and risk factor of infectious spondylodiscitis in children in Benin. Patients and Method: A descriptive cross-sectional study over 5 years was conducted in rheumatology and paediatric departments of National Hospital University Hubert Koutoukou Maga of Cotonou among children suffered from osteoarticular disorders. We selected patients with infectious spondylodyscitis. The data collected were analyzed using SPSS 20.0 software. Results: Among 179 children treated for osteo-articular disorders, 29 (16.2%) had infectious spondylodiscitis. There were 11 girls and 18 boys (sex ratio = 1.55). The main symptoms were dominated by low back pain (72.4). Fever was present in 58.6% of patients. Laboratory parameters of inflammation were higher than normal in all of the patients. Paraparesia was present in one case. L2-L3 disc was most affected (45.2% of cases). Mycobacterium tuberculosis was incriminated in 75,8%. Common places germs were dominated by negative baccillus germs (62.5%). The treatment was medical with a minimum duration of 3 months. All patients were immobilized with a lumbostat over a period of 3 months. Sicle cells disease, HIV, no BCG vaccination were the risk factors identified respectively in 9.4%, 11.3% and 16%. Conclusion: Diagnosis of spondylodiscitis in children is difficult in our country Keeping in mind unspecific subjective complaints and clinical findings. Early diagnosis uses magnetic resonance imaging which cost high and remains beyond the reach of our patients. Therefore, effective antibiotic therapy should be started promptly as soon as the diagnosis is suspected to avoid serious complications.展开更多
The authors present the case of a 48-year-old man admitted for acute onset of paraplegia in a patient suffering from backaches for 1 week. The rapidly progressive motor disturbances had been evolving for approximately...The authors present the case of a 48-year-old man admitted for acute onset of paraplegia in a patient suffering from backaches for 1 week. The rapidly progressive motor disturbances had been evolving for approximately 12 hours. The entire spinal MRI showed an epidural mass at T4-T6 associated with extensive lesions of spondylodiscitis and a T7-T8 vertebral body loss of height. A large six-level laminectomy was performed. A tumoral etiology couldn’t be entirely excluded intraoperatively so that no fusion has been done at that time. The pathological exam revealed acute inflammatory lesions with no argument in favor of a tumoral process. Bacteriological exam of the pathological specimen and stools cultures were positive for Salmonella brandenburg. An episode of gastroenteritis after the ingestion of a pizza has been evoked. The antibiotic medication was prescribed for 12 weeks. Postoperative evolution was favorable with a possible march between bars 6 weeks after. The authors emphasize the pseudo-tumoral presentation in an immunocompetent patient, the lack of complications and the post-ingestion mechanism.展开更多
Introduction: Pyogenic spondylodiscitis is a rare and severe complication of laparoscopic Sacro-Hysteropexy with a polypropylene mesh. The proper and early diagnosis following by medical treatment, if not responding, ...Introduction: Pyogenic spondylodiscitis is a rare and severe complication of laparoscopic Sacro-Hysteropexy with a polypropylene mesh. The proper and early diagnosis following by medical treatment, if not responding, so we shift to surgical approach is very important to prevent irreversible complications. Case Presentation: A female patient 32 years old admitted to our Gyne-Oncology unit in El-Galaa Maternity Teaching Hospital, in Jan 2022 with a significant weakness in both lower limbs up to complete paralysis, by history she has done a laparoscopic Hystero-Sacro-Pexy with synthetic polypropylene mesh 2 weeks ago, all investigations were normal except WBCs was 14,000 and CRP was 28, MRI Finding was an Encysted collection likely seroma at sacral promontory 4 × 3 cm, surgical removal of the mesh was done, the mesh related to the sacrum was severely infected and pus formation was noticed, 4 hours after the operation there was a Dramatic response and complete resolution of symptoms within few days. Conclusion: Because of the rarity of this complication in the literature, Spondylodiscitis awareness of symptoms, timely diagnosis, and treatment including surgical removal of synthetic mesh after Sacro-Pexy are fundamental to prevent irreversible complications.展开更多
A case of a patient with bilateral endophthalmitis and vertebral infection is presented here. The case presented with fever, general malaise, reduced vision and back pain for at least two weeks. Diagnosis was establis...A case of a patient with bilateral endophthalmitis and vertebral infection is presented here. The case presented with fever, general malaise, reduced vision and back pain for at least two weeks. Diagnosis was established by positive blood cultures together with ophthalmology review and radiological findings. Streptococcus dysgalactiae subspecies equisimilis was isolated from blood cultures. This case demonstrates the risks for older patients of developing invasive disease upon exposure to Streptococcus dysgalactiae, even if underlying diseases are absent.展开更多
Infectious spondylodiscitis in the elderly is a diagnostic and therapeutic emergency. They are mainly a functional and sometimes vital prognosis issue, with long-term chronic disabling sequelae and significant social ...Infectious spondylodiscitis in the elderly is a diagnostic and therapeutic emergency. They are mainly a functional and sometimes vital prognosis issue, with long-term chronic disabling sequelae and significant social costs. Study aim: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of infectious spondylodiscitis in the elderly in a rheumatological setting in Togo. Patients and methods: This was a multicenter, cross-sectional study conducted on the records of patients aged at least 65 years, suffering from infectious spondylodiscitis and hospitalized in four rheumatology units from their respective opening dates till December 31, 2020. Data collection lasted three months (December 1, 2020 to February 29, 2021). The diagnosis of infectious spondylodiscitis was radioclinical and laboratory-based. Results: 83 (49 women, 34 men) of the 1281 patients (6.48%) examined had infectious spondylodiscitis. The mean age at consultation was 70.59 ± 5.09 years, and the mean duration of the clinical course was 12 months. Spondylodiscitis was of tuberculous etiology (89.20%). It was most often found in the lumbar (56.62%) and dorsal (21.69%) segments. The location was multifocal in 12.05% of cases. It was associated with pulmonary involvement in 22.64% of cases. A neurological complication was identified in 48.19%. The main risk factors identified were promiscuity (48.82%), chronic alcoholism (18.07%), HIV infection (8.43%), diabetes (6.03%) and sickle cell disease (6.03%). The clinical course under medical treatment was favorable in 57 patients (68.68%). Conclusion: Infectious spondylodiscitis remains a frequent reason for hospitalization, tuberculosis being the most frequent etiology. Multifocal location, deterioration of general condition, gibbosity and neurological complications are exclusive to the elderly subject.展开更多
Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. A...Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.展开更多
<strong>Background:</strong> Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. <strong>Aim:&...<strong>Background:</strong> Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. <strong>Aim:</strong> To report a case of spondylodiscitis due to a transrectal prostate biopsy and highlight therapeutical principles. <strong>Case Presentation: </strong>A 60-year-old male underwent transrectal prostate biopsy performed because of high PSA level, and presented 48 hours later with back pain, fever at 40<span style="white-space:nowrap;">°</span>C associated with an obnubilation. He was treated for malaria without favorable evolution. Persistance of pain and occurrence of neurologic manifestations motivated dorso-lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which permitted diagnosis of spondylodiscitis. The treatment was made by triple antibiotic therapy combining Imipenem 500 mg/8h (IV);Ofloxacin 200 mg/12h (IV) and Metronidazole 500 mg/8h (IV) over four weeks. Evolution under treatment was favorable. <strong>Conclusion:</strong> Spondylodiscitis is an exceptional complication of transrectal prostate biopsy. It may be evocated in case of bones pain after prostate biopsy.展开更多
The localized forms of brucellosis, particularly osteoarticular, by their symptomatology usually nonspecific, still continue to be a diagnosis challenge, being fundamental to raise a high degree of suspicion based on ...The localized forms of brucellosis, particularly osteoarticular, by their symptomatology usually nonspecific, still continue to be a diagnosis challenge, being fundamental to raise a high degree of suspicion based on a careful epidemiological history. The authors describe the case of a 69 year old farmer that was admitted due to an insidious lower back pain with irradiation to the left lower limb accompanied by nocturnal sweating, anorexia and weight loss. The imaging studies revealed a spondylodiscitis in L3-L4 with an associated epidural abscess. The diagnosis of brucellosis was brought on by the occupational exposure to sheep and was confirmed by a positive PCR to Brucella in the product gathered by aspiration from the epidural abscess and also by the serology (ELISA and Rose Bengal). Despite the initial therapy with doxycycline, rifampicin and gentamycin (the last one for 1 week), the patient had a clinical and imagiologic worsening, determining surgical decompression. After the surgery, antiobiotherapy with doxycyline and rifampicin was maintained and a cycle of gentamicin was started, this time for a month, with a favorable clinical evolution.展开更多
Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a β-hemolytic Streptococcus that possesses genetic and clinical similarities to Streptococcus pyogenes. It is increasingly recognized as the etiological mic...Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a β-hemolytic Streptococcus that possesses genetic and clinical similarities to Streptococcus pyogenes. It is increasingly recognized as the etiological microorganism of invasive diseases. We report a case of a 74-year-old male who was admitted to this hospital with lower back and neck pain and infected with leg ulcer. The diagnosis of spondylodiscitis C2-C3 and L1-L3 caused by Streptococcus dysgalactiae subsp. equisimilis was made. The present case demonstrates the risk of older patients of developing invasive disease upon skin infection with Streptococcus dysgalactiae subsp. equisimilis, even when risk factors are absent or well controlled (as was diabetes mellitus in this case), suggesting that the pathogenic potential of SDSE should not be underestimated.展开更多
Background: Spondylodiscitis and spinal epidural abscesses are rare pathologic entities, but increasing in incidence. Group G beta hemolytic Streptococcus has been recently described associated with human infections. ...Background: Spondylodiscitis and spinal epidural abscesses are rare pathologic entities, but increasing in incidence. Group G beta hemolytic Streptococcus has been recently described associated with human infections. They often present clinically in a non-specific fashion, a fact which can lead to diagnostic delay, with serious consequences for the patient. Case Report: An 80-year-old man was admitted to the hospital with complaints of fever for three days, dysuria, hematuria, and back pain. Both septic embolizations and spondylodiscitis due to Group G beta hemolytic Streptococcus were detected. The patient was successfully treated with intravenous penicillin G for eight weeks, followed by oral amoxicillin for five months. Discussion: In all patients with spondylodiscitis, infective endocarditis should be considered, particularly in patients with heart valve disease history, since spondylodiscitis may be the presenting sign of an infective endocarditis. A high level of suspicion is therefore necessary in order correctly diagnose such entities as quickly as possible. The present case illustrates the pathogenic potential of group G streptococci in spondylodiscitis and native valve endocarditis.展开更多
Background: A descriptive study of the characteristics of brucellosis patients in Jordan and antimicrobial therapy. Methods: In an outpatient study, records were reviewed between July 2016 and April 2024 and electroni...Background: A descriptive study of the characteristics of brucellosis patients in Jordan and antimicrobial therapy. Methods: In an outpatient study, records were reviewed between July 2016 and April 2024 and electronically saved. Brucella diagnosis was based on epidemiological factors, risk factors, the standard tube agglutination test (STA), and blood or tissue cultures. Records were uploaded into a spreadsheet and imported into the R-Program. A 2-sample Kruskal-Wallis rank sum tested the equality of proportions between two treatment regimens for all available and spondylodiscitis, P Results: Two hundred patients with Brucellosis were analyzed;males 106 (53%) with a mean age of 46.8 years, and females 94 (47%) with a mean age of 48.1 years. Patients from Jordan were 159 (79.9%), and the Arabian Peninsula 25 (12.6%). Brucellosis was a non-focal presentation in 121 (60.50%) patients, spondylodiscitis in 64 (32.0%), and sacroiliitis in 7 (3.5%). Spondylodiscitis involved lumbar 48 (75.0%), thoracic 11 (17.20%), and cervical 5 (7.8%). STA was a common diagnostic method (188, 94%). Risk factors included cheese 80 (47.3%), cattle, small ruminants, and she-camel milk 37 (21.89%), dairy products 28 (16.57%), meat 9 (05.33%), and working with cattle 10 (05.92%). ESR was highest in spondylodiscitis (mean of 54.5). Imaging studies commonly requested were MRI and Bone scans. Doxycycline/Rifampin were mostly prescribed antimicrobials. Conclusion: There is no clear guidance on brucella treatment. In endemic areas, brucella is still a concern. Population education must be a priority. Support for randomized trials addressing antimicrobials and durations is extremely needed.展开更多
To report a rare case of fungal spondylodiscitis in a patient recovered from H7N9 virus infection and perform a literature review of the different characteristics of Candida and Aspergillus spondylodiscitis, we review...To report a rare case of fungal spondylodiscitis in a patient recovered from H7N9 virus infection and perform a literature review of the different characteristics of Candida and Aspergillus spondylodiscitis, we reviewed cases of spondylodiscitis caused by Candida and Aspergillus species. Data, including patients＇ information, patho- genic species, treatment strategy, outcomes, and relapses, were collected and summarized. The characteristics of Canclida and Aspergillus spondylodiscitis were compared to see if any differences in clinical features, management, or consequences could be detected. The subject of the case study was first misdiagnosed as having a vertebral tumor, and then, following open biopsy, was diagnosed as having fungal spondylodiscitis. The patient made a good recovery following radical debridement. Seventy-seven additional cases of Candida spondylodiscitis and 94 cases of Asper- gillus spondylodiscitis were identified in the literature. Patients with Candida spondylodiscitis tended to have a better outcome than patients with Aspergillus spondylodiscitis （cure rate 92.3% vs. 70.2%）. Candida was found more fre- quently （47.8%） than Aspergillus （26.7%） in blood cultures, while neurological deficits were observed more often in patients with Aspergillus spondylodiscitis （43.6% vs. 25.6%）. Candida spinal infections were more often treated by radical debridement （60.5% vs. 39.6%）. Patients with Candida spondylodiscitis have better outcomes, which may be associated with prompt recognition, radical surgical debridement, and azoles therapy. A good outcome can be ex- pected in fungal spondylodiscitis with appropriate operations and anti-fungal drugs.展开更多
Solid organ transplant recipients are at increased risk for Aspergillus infections. However, the cases of Aspergillus spondylodiscitis are rare and mostly resulted from the hematogenous spread of invasive pulmonary As...Solid organ transplant recipients are at increased risk for Aspergillus infections. However, the cases of Aspergillus spondylodiscitis are rare and mostly resulted from the hematogenous spread of invasive pulmonary Aspergillosis. Here, we report a case of primary spondylodiscitis in a liver transplant recipient. Six months after transplantation, a chronic and progressive lumbar back pain was presented. The patient had no fever and the white blood cell count was normal. High plasma （l^3）-beta-d-glucan （BDG） level was detected at the time of back pain. The pathogen was Aspergillus flavus. Clinical and radiological healing was achieved through posterior only debridement and voriconazole therapy.展开更多
文摘Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.
文摘Background: Spondylodiscitis is a spinal infection rare affecting primarily the intervertebral disk and the adjacent vertebral bodies. His diagnosis is difficult and often delayed or missed due to the rarity of the disease. Cervical spondylodiscitis has quite rare findings regarding the common location of spinal abscesses in the lumbar and thoracic regions. To obtain the best patient outcomes, these spinal infections require prompt diagnosis and appropriate treatment. Case description: A 44-year-old boy was admitted to the neurosurgery department of our hospital for heaviness in 4 limbs without gait disorders in context infected tracheostomy after staying in intensive care. MRI spine showed a spine deformity with lyse C4C5 epiduritis and spinal cord compressed. Antibiotics intravenous were started for 1 month the patient benefited from a corpectomy with an iliac graft and anterior cervical plate. The anatomopathological examination revealed an inflammation not specific. He was therefore put on antibiotics for 6 weeks. Three months later the neck pain and limb pain resolved after treatment and a complete return of lower extremity strength. Conclusion: Cervical spondylodiscitis has increased and become more aggressive. While radical surgical debridement, stable reconstruction together with antibiotic therapy remained a reliable approach to achieve complete healing of the inflammation, anterior alone surgery became more applicable.
基金supported by Hubei Provincial Natural Science Foundation of China (No.2012FFB02322)
文摘Summary： The effect and safety of anterior debridement and fusion with a minimally invasive ap- proach combined with posterior fixation via the Wiltse approach were assessed in the single-level lum- bar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients＇ general information, mi- crobiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association （ASIA） im- pairment, visual analogue scale （VAS）, and Oswestry Disability Index （ODI）. Ten patients had under- gone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments in- cluded L1-2, L2-3, L3,~, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were posi- tive for Staphylococcus aureus （5 cases）, Staphylococcus epidermidis （4）, Streptococcus （3）, and Es- cherichia coli （1）. The operative time was 213.8＋45.6 min, and the intraoperative blood loss was 180.6-4-88.1 mL. Postoperative complications consisted of urinary retention （2 cases）, constipation （3）, and deep vein thrombosis （2）. On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with poste- rior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondy- lodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.
文摘BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
文摘<b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> T</span><span style="font-family:Verdana;">he </span><span style="font-family:Verdana;">o</span><span style="font-family:Verdana;">bjective is to</span><span style="font-family:""><span style="font-family:Verdana;"> determine the frequency and the semiological and evolutionary profiles of infectious spondylodiscitis in hospital practice in Kara. </span><b><span style="font-family:Verdana;">Patients</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">methods:</span></b><span style="font-family:Verdana;"> This was a cross-sectional study of a case series of patients with infectious spondylodiscitis, who were admitted to the rheumatology department of Kara University Hospital in North Togo. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Among the 3972 examined patients, 86 (33 males and 53 females) patients (2.16%) had infectious spondylodiscitis. The average age of these patients at the onset of the disease was 47.20 years. The average duration of the disease was 11.41 months. Tuberculosis was suspected in 77 of 86 patients (89.53%). The infectious spondylodiscitis most often affected the lumbar (51.04%) and dorsal (21.87%) segments and was associated with a pulmonary location in 31 patients (36.04%). In addition to underdevelopment and poor hygiene (72 cases), alcoholism (15 cases) and human immunodeficiency virus infection (10 cases) were the main risk factors identified. The progress with the medical treatment was favorable in 65 patients (75.58%) and 16 patients were lost to follow-up. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The frequency of infectious spondylodiscitis reflects the underdevelopment and poor hygiene levels in Black Africa. Its etiology is most commonly associated with tuberculosis and remains a concern despite the epidemiological transition of the different diseases.
文摘Postoperative spondylodiscitis is a rare but serious complication after lumbar disc surgery.Most cases are due to more virulent organisms such as Staphylococcus aureus and Streptococcus.No case of post operative tubercular spondylodiscitis has been reported till date to our knowledge. We are reporting a case of tubercular spondylodiscitis followed by lumbar disc surgery of L2-3 level.
文摘Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.
文摘Aim: To determine the prevalence and risk factor of infectious spondylodiscitis in children in Benin. Patients and Method: A descriptive cross-sectional study over 5 years was conducted in rheumatology and paediatric departments of National Hospital University Hubert Koutoukou Maga of Cotonou among children suffered from osteoarticular disorders. We selected patients with infectious spondylodyscitis. The data collected were analyzed using SPSS 20.0 software. Results: Among 179 children treated for osteo-articular disorders, 29 (16.2%) had infectious spondylodiscitis. There were 11 girls and 18 boys (sex ratio = 1.55). The main symptoms were dominated by low back pain (72.4). Fever was present in 58.6% of patients. Laboratory parameters of inflammation were higher than normal in all of the patients. Paraparesia was present in one case. L2-L3 disc was most affected (45.2% of cases). Mycobacterium tuberculosis was incriminated in 75,8%. Common places germs were dominated by negative baccillus germs (62.5%). The treatment was medical with a minimum duration of 3 months. All patients were immobilized with a lumbostat over a period of 3 months. Sicle cells disease, HIV, no BCG vaccination were the risk factors identified respectively in 9.4%, 11.3% and 16%. Conclusion: Diagnosis of spondylodiscitis in children is difficult in our country Keeping in mind unspecific subjective complaints and clinical findings. Early diagnosis uses magnetic resonance imaging which cost high and remains beyond the reach of our patients. Therefore, effective antibiotic therapy should be started promptly as soon as the diagnosis is suspected to avoid serious complications.
文摘The authors present the case of a 48-year-old man admitted for acute onset of paraplegia in a patient suffering from backaches for 1 week. The rapidly progressive motor disturbances had been evolving for approximately 12 hours. The entire spinal MRI showed an epidural mass at T4-T6 associated with extensive lesions of spondylodiscitis and a T7-T8 vertebral body loss of height. A large six-level laminectomy was performed. A tumoral etiology couldn’t be entirely excluded intraoperatively so that no fusion has been done at that time. The pathological exam revealed acute inflammatory lesions with no argument in favor of a tumoral process. Bacteriological exam of the pathological specimen and stools cultures were positive for Salmonella brandenburg. An episode of gastroenteritis after the ingestion of a pizza has been evoked. The antibiotic medication was prescribed for 12 weeks. Postoperative evolution was favorable with a possible march between bars 6 weeks after. The authors emphasize the pseudo-tumoral presentation in an immunocompetent patient, the lack of complications and the post-ingestion mechanism.
文摘Introduction: Pyogenic spondylodiscitis is a rare and severe complication of laparoscopic Sacro-Hysteropexy with a polypropylene mesh. The proper and early diagnosis following by medical treatment, if not responding, so we shift to surgical approach is very important to prevent irreversible complications. Case Presentation: A female patient 32 years old admitted to our Gyne-Oncology unit in El-Galaa Maternity Teaching Hospital, in Jan 2022 with a significant weakness in both lower limbs up to complete paralysis, by history she has done a laparoscopic Hystero-Sacro-Pexy with synthetic polypropylene mesh 2 weeks ago, all investigations were normal except WBCs was 14,000 and CRP was 28, MRI Finding was an Encysted collection likely seroma at sacral promontory 4 × 3 cm, surgical removal of the mesh was done, the mesh related to the sacrum was severely infected and pus formation was noticed, 4 hours after the operation there was a Dramatic response and complete resolution of symptoms within few days. Conclusion: Because of the rarity of this complication in the literature, Spondylodiscitis awareness of symptoms, timely diagnosis, and treatment including surgical removal of synthetic mesh after Sacro-Pexy are fundamental to prevent irreversible complications.
文摘A case of a patient with bilateral endophthalmitis and vertebral infection is presented here. The case presented with fever, general malaise, reduced vision and back pain for at least two weeks. Diagnosis was established by positive blood cultures together with ophthalmology review and radiological findings. Streptococcus dysgalactiae subspecies equisimilis was isolated from blood cultures. This case demonstrates the risks for older patients of developing invasive disease upon exposure to Streptococcus dysgalactiae, even if underlying diseases are absent.
文摘Infectious spondylodiscitis in the elderly is a diagnostic and therapeutic emergency. They are mainly a functional and sometimes vital prognosis issue, with long-term chronic disabling sequelae and significant social costs. Study aim: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of infectious spondylodiscitis in the elderly in a rheumatological setting in Togo. Patients and methods: This was a multicenter, cross-sectional study conducted on the records of patients aged at least 65 years, suffering from infectious spondylodiscitis and hospitalized in four rheumatology units from their respective opening dates till December 31, 2020. Data collection lasted three months (December 1, 2020 to February 29, 2021). The diagnosis of infectious spondylodiscitis was radioclinical and laboratory-based. Results: 83 (49 women, 34 men) of the 1281 patients (6.48%) examined had infectious spondylodiscitis. The mean age at consultation was 70.59 ± 5.09 years, and the mean duration of the clinical course was 12 months. Spondylodiscitis was of tuberculous etiology (89.20%). It was most often found in the lumbar (56.62%) and dorsal (21.69%) segments. The location was multifocal in 12.05% of cases. It was associated with pulmonary involvement in 22.64% of cases. A neurological complication was identified in 48.19%. The main risk factors identified were promiscuity (48.82%), chronic alcoholism (18.07%), HIV infection (8.43%), diabetes (6.03%) and sickle cell disease (6.03%). The clinical course under medical treatment was favorable in 57 patients (68.68%). Conclusion: Infectious spondylodiscitis remains a frequent reason for hospitalization, tuberculosis being the most frequent etiology. Multifocal location, deterioration of general condition, gibbosity and neurological complications are exclusive to the elderly subject.
文摘Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.
文摘<strong>Background:</strong> Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. <strong>Aim:</strong> To report a case of spondylodiscitis due to a transrectal prostate biopsy and highlight therapeutical principles. <strong>Case Presentation: </strong>A 60-year-old male underwent transrectal prostate biopsy performed because of high PSA level, and presented 48 hours later with back pain, fever at 40<span style="white-space:nowrap;">°</span>C associated with an obnubilation. He was treated for malaria without favorable evolution. Persistance of pain and occurrence of neurologic manifestations motivated dorso-lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which permitted diagnosis of spondylodiscitis. The treatment was made by triple antibiotic therapy combining Imipenem 500 mg/8h (IV);Ofloxacin 200 mg/12h (IV) and Metronidazole 500 mg/8h (IV) over four weeks. Evolution under treatment was favorable. <strong>Conclusion:</strong> Spondylodiscitis is an exceptional complication of transrectal prostate biopsy. It may be evocated in case of bones pain after prostate biopsy.
文摘The localized forms of brucellosis, particularly osteoarticular, by their symptomatology usually nonspecific, still continue to be a diagnosis challenge, being fundamental to raise a high degree of suspicion based on a careful epidemiological history. The authors describe the case of a 69 year old farmer that was admitted due to an insidious lower back pain with irradiation to the left lower limb accompanied by nocturnal sweating, anorexia and weight loss. The imaging studies revealed a spondylodiscitis in L3-L4 with an associated epidural abscess. The diagnosis of brucellosis was brought on by the occupational exposure to sheep and was confirmed by a positive PCR to Brucella in the product gathered by aspiration from the epidural abscess and also by the serology (ELISA and Rose Bengal). Despite the initial therapy with doxycycline, rifampicin and gentamycin (the last one for 1 week), the patient had a clinical and imagiologic worsening, determining surgical decompression. After the surgery, antiobiotherapy with doxycyline and rifampicin was maintained and a cycle of gentamicin was started, this time for a month, with a favorable clinical evolution.
文摘Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a β-hemolytic Streptococcus that possesses genetic and clinical similarities to Streptococcus pyogenes. It is increasingly recognized as the etiological microorganism of invasive diseases. We report a case of a 74-year-old male who was admitted to this hospital with lower back and neck pain and infected with leg ulcer. The diagnosis of spondylodiscitis C2-C3 and L1-L3 caused by Streptococcus dysgalactiae subsp. equisimilis was made. The present case demonstrates the risk of older patients of developing invasive disease upon skin infection with Streptococcus dysgalactiae subsp. equisimilis, even when risk factors are absent or well controlled (as was diabetes mellitus in this case), suggesting that the pathogenic potential of SDSE should not be underestimated.
文摘Background: Spondylodiscitis and spinal epidural abscesses are rare pathologic entities, but increasing in incidence. Group G beta hemolytic Streptococcus has been recently described associated with human infections. They often present clinically in a non-specific fashion, a fact which can lead to diagnostic delay, with serious consequences for the patient. Case Report: An 80-year-old man was admitted to the hospital with complaints of fever for three days, dysuria, hematuria, and back pain. Both septic embolizations and spondylodiscitis due to Group G beta hemolytic Streptococcus were detected. The patient was successfully treated with intravenous penicillin G for eight weeks, followed by oral amoxicillin for five months. Discussion: In all patients with spondylodiscitis, infective endocarditis should be considered, particularly in patients with heart valve disease history, since spondylodiscitis may be the presenting sign of an infective endocarditis. A high level of suspicion is therefore necessary in order correctly diagnose such entities as quickly as possible. The present case illustrates the pathogenic potential of group G streptococci in spondylodiscitis and native valve endocarditis.
文摘Background: A descriptive study of the characteristics of brucellosis patients in Jordan and antimicrobial therapy. Methods: In an outpatient study, records were reviewed between July 2016 and April 2024 and electronically saved. Brucella diagnosis was based on epidemiological factors, risk factors, the standard tube agglutination test (STA), and blood or tissue cultures. Records were uploaded into a spreadsheet and imported into the R-Program. A 2-sample Kruskal-Wallis rank sum tested the equality of proportions between two treatment regimens for all available and spondylodiscitis, P Results: Two hundred patients with Brucellosis were analyzed;males 106 (53%) with a mean age of 46.8 years, and females 94 (47%) with a mean age of 48.1 years. Patients from Jordan were 159 (79.9%), and the Arabian Peninsula 25 (12.6%). Brucellosis was a non-focal presentation in 121 (60.50%) patients, spondylodiscitis in 64 (32.0%), and sacroiliitis in 7 (3.5%). Spondylodiscitis involved lumbar 48 (75.0%), thoracic 11 (17.20%), and cervical 5 (7.8%). STA was a common diagnostic method (188, 94%). Risk factors included cheese 80 (47.3%), cattle, small ruminants, and she-camel milk 37 (21.89%), dairy products 28 (16.57%), meat 9 (05.33%), and working with cattle 10 (05.92%). ESR was highest in spondylodiscitis (mean of 54.5). Imaging studies commonly requested were MRI and Bone scans. Doxycycline/Rifampin were mostly prescribed antimicrobials. Conclusion: There is no clear guidance on brucella treatment. In endemic areas, brucella is still a concern. Population education must be a priority. Support for randomized trials addressing antimicrobials and durations is extremely needed.
基金Project supported by the Zhejiang Medical Technology and Education Foundation(No.2015107339),China
文摘To report a rare case of fungal spondylodiscitis in a patient recovered from H7N9 virus infection and perform a literature review of the different characteristics of Candida and Aspergillus spondylodiscitis, we reviewed cases of spondylodiscitis caused by Candida and Aspergillus species. Data, including patients＇ information, patho- genic species, treatment strategy, outcomes, and relapses, were collected and summarized. The characteristics of Canclida and Aspergillus spondylodiscitis were compared to see if any differences in clinical features, management, or consequences could be detected. The subject of the case study was first misdiagnosed as having a vertebral tumor, and then, following open biopsy, was diagnosed as having fungal spondylodiscitis. The patient made a good recovery following radical debridement. Seventy-seven additional cases of Candida spondylodiscitis and 94 cases of Asper- gillus spondylodiscitis were identified in the literature. Patients with Candida spondylodiscitis tended to have a better outcome than patients with Aspergillus spondylodiscitis （cure rate 92.3% vs. 70.2%）. Candida was found more fre- quently （47.8%） than Aspergillus （26.7%） in blood cultures, while neurological deficits were observed more often in patients with Aspergillus spondylodiscitis （43.6% vs. 25.6%）. Candida spinal infections were more often treated by radical debridement （60.5% vs. 39.6%）. Patients with Candida spondylodiscitis have better outcomes, which may be associated with prompt recognition, radical surgical debridement, and azoles therapy. A good outcome can be ex- pected in fungal spondylodiscitis with appropriate operations and anti-fungal drugs.
文摘Solid organ transplant recipients are at increased risk for Aspergillus infections. However, the cases of Aspergillus spondylodiscitis are rare and mostly resulted from the hematogenous spread of invasive pulmonary Aspergillosis. Here, we report a case of primary spondylodiscitis in a liver transplant recipient. Six months after transplantation, a chronic and progressive lumbar back pain was presented. The patient had no fever and the white blood cell count was normal. High plasma （l^3）-beta-d-glucan （BDG） level was detected at the time of back pain. The pathogen was Aspergillus flavus. Clinical and radiological healing was achieved through posterior only debridement and voriconazole therapy.
