A complicated case of a spinal Scedosporium apiospermum infection with a favorable outcome—case report

Scedosporium apiospermum is a ubiquitous species of ascomycete fungi. Human infections occur mostly as opportunistic infections in immunocompromised patients. Risk factors for immunocompetent patients are penetrating trauma, surgery, and near-drowning accidents. We report a complicated postsurgical infection with S. apiospermum in a 66-year-old immunocompetent adult. After microsurgical lumbar decompression, the patient developed an extensive infection in the area of the operation with sub- and epidural abscess collection, spondylodiscitis, polyradiculitis, and arachnoiditis. S. apiospermum was recovered from multiple cultures of tissue samples as well as from implant material. Despite early initiation of voriconazole therapy and surgical intervention, the progressive infection of multiple lumbar nerve roots could not be prevented and the patient developed distal sensorimotor paraparesis. Only after 10 months of continuous oral voriconazole therapy and repeated surgical procedures to replace all implant material did stabilization and clinical improvement occur. Finally, fungus was no longer detected and the patient slowly but steadily regained walking ability.