Spinal epidural aspergillosis due to a lung aspergilloma despite long-termitraconazole treatment

A 58-year-old man developed spinal cord compression at the T2-T3 level due to an Aspergillus epidural abscess. This presumably immunocompetent patient had been treated for two years by oral itraconazole (200 mg/day) for a lun g aspergilloma that occurred seven years after removal of a lung adenocarci noma. Surgical debridement was performed via a wide posterior approach asso ciated with high-dose amphotericin B. Five months later, the patient's neur ological deficit had not improved and the patient died from respiratory fai lure. Despite a long-term treatment with itraconazole, the infection spread locally from a lung aspergilloma to the epidural space.