Vertebral Aspergillus osteomyelitis and acute diskitis in patients with chronic obstructive pulmonary disease

Aspergillus osteomyelitis of the spine with acute diskitis has been well do cumented in immunocompromised hosts but is rare in immunocompetent patients . Predisposing factors to infection are prolonged neutropenia, hematologic malignancies, chemotherapy, history of prior spinal trauma or surgery, allo graft transplantation, or any condition requiring the use of long-term immu nosuppressive agents or systemic corticosteroids. Patients with chronic obs tructive pulmonary disease (COPD) treated with systemic corticosteroids for either long-term management or frequent exacerbations are at potential ris k for such infections. Patients with severe COPD treated primarily with inh aled corticosteroids are considered immunocompetent. This report describes 2 cases of Aspergillus osteomyelitis with acute diskitis in apparently immu nocompetent patients with COPD who, aside from brief courses of systemic co rticosteroids, were using inhaled corticosteroid therapy. One patient was t reated with intravenous amphotericin B alone, whereas the other received am photericin B and underwent surgical debridement. Both have done well and we re symptom free at 6-month follow-up.