M Shaffi, Najam Siddiqi, Ijaz Ahmed.
Quadriplegia due to Aspergillosis of Cervicodorsal Spine.
J Coll Physicians Surg Pak Jan ;10(8):308-11.

A case of aspergillus infection of the lungs, which eroded the cervical vertebra resulting In quadriplegia, is reported. Initially, the patient was treated as a case of tuberculosis but he did not respond and the disease progressed. In a short period of few months quadriplegia was developed. Leminectomy at the cervical region was carried out. Biopsy revealed aspergillosis. Antifungal treatment was initiated postoperatively, however, patient did not improve and passed away after one month.

CASE REPORT: A 52-year old female was referred to Darul Shifa Hospital, Islamabad with quadriplegia of one week duration. The patient was a housewife with six children. The symptoms started with fever and cough about 12 months ago and increased progressively till 4 months ago, when she was seen by a physician and had an x-ray chest and blood tests. The chest X-ray showed an opacity in the right apical region of the lung and ESR 54 mm in the 1st hour. A tentative diagnosis of pulmonary tuberculosis was made and the patient kept on anti-TB therapy. She did not improve with medication. Later she developed neck pain radiating to both upper limbs. The pain was severe at night. About two weeks later she developed sensory disturbances and motor weakness of upper limbs. Four weeks before her admission into r` hospital she noted weakness of lower limbs which progressively over period of days till she was unable to w and became bed ridden. When examined at Darul Shifa Hospital, the lady was q , ill, looked pale and was lying motionless in bed. BP 140/100, pulse 92/min and respiratory rate 26/min. mental functions were intact. She was tender at lower spine with the evidence of diffuse swelling in that area. was gross weakness of all the four limbs with wasting muscles at both shoulder girdle and hands. She was unable feed herself or move out of the bed. Tendon reflexes of and lower limbs were depressed. Sensory loss was ` spread in the limbs and torso. She had lost control over and bladder sphincters. A urinary catheter was in Provisional diagnosis of cord compression at lower spine due to caries spine or tumor was made and the was further investigated.

All the previous X-ray films were again studied care the film of August 1998, a small opacity in the right lung region was seen, while soft tissue mass in the right lung mediastinum in the apical region was present. At the December, 1998 the mass had considerably increased in sizes was extending to the madiastinum X-rays of the cervical and thoracic spine showed destructive lesions involving lower two cervical C6-C7 and upper four thoracic vertebrae T1-T4 (Figure 2). The destruction of the Pedicles, laminae and spinous processes was found on CT scan and C7, Tl and T2 vertebrae were destroyed the most (Figure 3). The adjoining parts of the ribs were also involved in the process of destruction. There was no obvious mass seen. The CT scan of cervical and upper thoracic spine and lungs confirmed the findings seen on plan radiography. A mass was present in the upper part of the right lung with uniform density. It was extending to the mediastinum but was separate from it.

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