# Metagenomic next-generation sequencing enabled diagnosis of Aspergillus spondylitis in an immunocompetent patient: a case report and literature review

## TL;DR

A rare case of Aspergillus spondylitis in an immunocompetent patient was diagnosed using metagenomic sequencing and confirmed with surgery and treatment.

## Contribution

Reports a rare case of Aspergillus spondylitis in an immunocompetent patient diagnosed via metagenomic sequencing.

## Key findings

- Metagenomic next-generation sequencing confirmed Aspergillus spondylitis in an immunocompetent patient.
- Aspergillus spondylitis presents with specific imaging features like endplate inflammatory response and paraspinal abscesses.
- Early diagnosis and treatment with voriconazole and surgery improved patient prognosis.

## Abstract

Aspergillus fumigatus spondylitis is a rare fungal spondylitis that often occurs in immunocompromised patients. This article reports a case of Aspergillus spondylitis with specific image signs, which is rarely reported in an immunocompetent patient.

This is a case of L3-4 segmental Aspergillus spondylitis diagnosed. The diagnosis was confirmed by intraoperative metagenomic next-generation sequencing (mNGS) testing of the diseased tissue. The patient was treated with voriconazole and underwent surgical debridement and internal fixation with pedicle screws.

The diagnosis of Aspergillus spondylitis is often delayed or missed. Doctors should consider Aspergillus spondylitis in the differential diagnosis of unexplained low back pain so that appropriate treatment can be administered to prevent spinal cord injury and disability. Aspergillus spondylitis usually results in endplate inflammatory response line on fluid or enhancement sequences and a diffuse low signal in the diseased vertebral body on T2-weighted imaging (T2WI). It also results in large paraspinal abscesses, which requires further research to better differentiate between Aspergillus spondylitis and tuberculous spondylitis. Prompt diagnosis and treatment can improve the patient’s prognosis.