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Postoperative Trichosporon asahii spondylodiscitis after open lumbar discectomy: a case report.

Spine 2008 Februrary 16
STUDY DESIGN: A case report of Trichosporon asahii spondylodiscitis.

OBJECTIVE: To report the first case of T. asahii spondylodiscitis that developed in a healthy woman at the site of an open lumbar discectomy.

SUMMARY OF BACKGROUND DATA: Trichosporon is a genus of basidiomycetous yeasts that is common in nature and a member of the normal flora of the mouth, skin, and nails. It causes deep infections and fungemia mainly in immunocompromised patients or patients with underlying hematologic malignancies. To our knowledge, there is no reported case of bone and joint infections caused by T. asahii.

METHODS: A 42-year-old female gynecologist was transferred to our hospital with a chief complaint of severe lower back pain after an open L4-L5 discectomy. The infection indexes showed an elevated erythrocyte sedimentation rate and the C-reactive protein. Despite bed rest and antibiotic therapy, the lower back pain and tingling sensation on both lower extremities continued to worsen. The magnetic resonance imaging showed an abscess-like fluid collection compressing the thecal sac and showed a signal change in the bone marrow of the L4 and L5 vertebral bodies, suggesting spondylodiscitis. Laminectomy, curettage, and debridement of the infected discs were performed. Cultures of the abscess yielded yeasts that were sensitive to fluconazole. The yeast was identified as T. asahii.

RESULTS: She received fluconazole therapy for 5 months, and returned to her work after the fourth postoperative month. She has remained in a satisfactory condition since.

CONCLUSION: We present the first case of T. asahii spondylodiscitis, which developed unexpectedly in a healthy woman at the site of an open lumbar discectomy. We successfully treated the patient with surgical debridement and 5 months of fluconazole therapy.

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