Invasive aspergillosis following spine surgery

Aspergillus infections of the central nervous system are rare and typically involve the brain by contiguous spread from sino-nasal sites. Spinal cord involvement is reported occasionally. Usual associations are immunocompromised states, and post-operative infections are very rare. This is a report of a sixty-six year old post lumbar laminectomy patient presenting with a sub-acute paraparesis followed by fulminant meningoencephalitis which ultimately proved fatal. His MRI showed evidence of chronic infection at the surgical site, and features of inflammation within the spinal cord and basal leptomeninges. Hydrocephalus, exudates and haemorrhages were also present. CSF showed neutrophilic pleocytosis with hypoglycorrhachia, and segmented filamentous hyphae were noted on the CSF smear. Cultures grew Aspergillus terreus. CT Thorax showed multiple parenchymal lung nodules with cavitation, consistent with fungal infection. This unique presentation of Aspergillosis highlights the need to consider fungal infections as differentials in paraparetic presentation followed by fulminant meningitis in the setting of prior spine surgery