Publication

Abstract : Aspergillus sp are opportunistic pathogens. Aspergillus fumigatus accounts for the majority of disease, followed by Aspergillus flavus. The lungs and skin are most commonly involved. Exclusive musculoskeletal involvement is very rare, more so with A. flavus, which is primarily a plant/avian pathogen. A 63-year-old diabetic male with progressive lower backache was considered for 99mTc-MDP (methylene diphosphate) whole body skeletal scintigraphy, as his hematological tests and a magnetic resonance image (MRI) of the spine were non-contributory. Hot spots were seen in the L4, L5, and S1 vertebrae and the right sacroiliac, hip, and right knee joints (Figure 1). Right hip aspiration and effusion Gram staining showed only inflammatory cells. A culture of post-arthrotomy drainage fluid from the right hip and knee joints grew filamentous fungus A. flavus (Figure 2). A computed tomography (CT) scan of the chest ruled out associated pulmonary aspergillosis. Thus the bone scan proved invaluable in revealing the polyarticular involvement, as well as identifying the sites of active disease. The patient was treated successfully with voriconazole.