Aspergillus osteomyelitis after liver transplantation: conservative or surgical treatment?

We report on a liver transplant recipient who developed coxarthritis and lu mbar spondylodiscitis due to Aspergillus flavus. He was treated with high-d ose liposomal amphotericin B for 2 months followed by itraconazole. Because of intractable pain and severe, irreversible damage of the left hip, a Gir dlestone resection was performed. The spondylodiscitis was treated successf ully with anti-fungal agents only, which indicates that, in the absence of neurological impairment, good clinical outcome can be achieved without surg ery. This case demonstrates that surgical therapy, which is often proclaime d as unavoidable for the treatment of Aspergillus osteomyelitis, should be considered in particular in the case of intolerable pain due to irreversibl e joint damage or involvement of vital organs. (C) 2000 Lippincott Williams & Wilkins.