Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3251-3260
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3251
Scedosporium apiospermum infection of the lumbar vertebrae: A case report
Xue-Wen Shi, Sheng-Tang Li, Jin-Peng Lou, Bo Xu, Jian Wang, Xin Wang, Hua Liu, Song-Kai Li, Ping Zhen, Tao Zhang
Xue-Wen Shi, Sheng-Tang Li, Jin-Peng Lou, Bo Xu, Jian Wang, Xin Wang, Hua Liu, Song-Kai Li, Ping Zhen, Tao Zhang, Orthopaedic Centers, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Xue-Wen Shi, Jin-Peng Lou, Xin Wang, Orthopaedic Centers, The Clinical Medical College of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
Sheng-Tang Li, Bo Xu, Orthopaedic Centers, The Second Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China
Jian Wang, Orthopaedic Centers, The Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu Province, China
Author contributions: Shi XW, Li ST, Lou JP, and Zhang T provided the concept for the study and drafted the manuscript; Xu B, Wang X, and Wang J provided the images; Liu H, Li SK, Zheng P, and Zhang T performed the operations; all authors have read and approved the content of the manuscript.
Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program, No. 20QNPY071.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Zhang, MM, Attending Doctor, Orthopaedic Centers, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, No. 333 Nanbinhe Road, Lanzhou 730050, Gansu Province, China. 526199753@qq.com
Received: October 18, 2021
Peer-review started: October 18, 2021
First decision: December 17, 2021
Revised: December 31, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 6, 2022
Processing time: 161 Days and 21.3 Hours
Abstract
BACKGROUND

Scedosporium apiospermum (S. apiospermum) is a clinically rare and aggressive fungus mainly found in contaminated water, wetlands, decaying plants, stagnant water, and potted plants in hospitals. The lung, bone, joint, eye, brain, skin, and other sites are easily infected, and there is a marked risk of misdiagnosis. There have been few case reports of infection by S. apiospermum of the lumbar vertebrae; most reports have focused on infection of the lung.

CASE SUMMARY

An otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain, stooping, and limited walking. The symptoms were significantly aggravated 10 d prior to hospitalization, and radiating pain in the back of his left lower leg developed, which was so severe that he could not walk. Movement of the lumbar spine was significantly limited, anterior flexion was about 30°; backward extension, right and left lateral curvature, and rotational mobility were about 10°; tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident, and the muscle strength of both lower limbs was grade IV. Imaging suggested bony destruction of the lumbar 3, 4, and 5 vertebrae and sacral 1 vertebra; in addition, the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable. Lumbar vertebral infection was also noted, and the possibility of lumbar tuberculosis was considered. We first performed surgical intervention on the lesioned lumbar vertebrae, cleared the infected lesion, and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device, which restored the stability of the lumbar vertebrae. Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S. apiospermum infection of the lumbar vertebrae; on this basis, the patient was administered voriconazole. At the 6-mo follow-up, efficacy was significant, no drug-related side effects were observed, and imaging examination showed no evidence of recurrence.

CONCLUSION

S. apiospermum infection can occur in immunocompetent individuals with no history of near drowning. Voriconazole is effective for the treatment of S. apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.

Keywords: Scedosporium apiospermum; Lumbar vertebrae; Fungal infection; Treatment; Voriconazole; Case report

Core Tip: Scedosporium apiospermum (S. apiospermum) infection can occur in immunocompetent individuals with no history of a near drowning event. S. apiospermum infection of the lumbar vertebrae is rare, leading to risks of misdiagnosis and mistreatment. Cytology and pathology of lesion tissue play a decisive role in diagnosis. Further cases would expand our understanding of this rare fungal infection.