Chronic spinal epidural abscess caused by Scedosporium prolificans in an immunocompetent patient.

Study Design: Case report and clinical discussion.

Objective: To describe a rare case of chronic spinal epidural abscess caused by Scedosporium prolificans in an immunocompetent patient.

Summary Of Background Data: S. prolificans is an emerging multiresistant fungal pathogen that may cause a wide variety of infections, whose severity depends of the patient's immune status.

Methods: A 35-year-old Brazilian man developed a 5-year chronic progressive paresis in lower limbs followed by sphincter dysfunction. Spinal magnetic resonance imaging revealed a thoracic-lumbar epidural mass that heterogeneously enhanced gadolinium. Spinal biopsy showed a chronic inflammatory process localized in epidural thoracic spine. S. prolificans was isolated in a specific culture.

Results: He was treated with endovenous voriconazole for 2 weeks followed by oral voriconazole for 90 days. Three months later, a T9-T10 epidural mass was detected on a new magnetic resonance imaging. The abscess was drained, and the culture of the material confirmed the persistence of infection by S. prolificans. A progressive paraparesis due to chronic meningo-myelitis was observed at a 6-month follow-up. Although patient was treated with caspofungin, terbinafine, and voriconazole, no improvement was observed.

Conclusion: S. prolificans can cause chronic epidural abscess and spine infection in immunocompetent patients. The potential resistance of S. prolificans to antifungal agents should be borne in mind.