Three children, ages 14-15 years, who developed myelopathy as the first manifestation of invasive aspergillosis are reported from the Children’s Hospital Los Angeles, University of Southern California. All were immunosuppressed because of chemotherapy and antibiotics for treatment of leukemia. Symptoms presented with leg weakness and pain, followed in 2 to 6 days by loss of pain and temperature sensation, and finally complete myelopathy, with proprioceptive loss and urinary incontinence. One patient had brain involvement also, manifesting with delirium, spasticity, and arm weakness. Despite aggressive antifungal therapy, the patients died within 1 month of onset of symptoms. Postmortem findings showed multifocal meningeal exudates, cerebral and spinal hemorrhagic necrosis, and fungal abscess in the cord of one child, and aortic endarteritis, spinal necrosis and intramedullary hematoma in a second. A third, without postmortem, had shown CT and MRI evidence of a paravertebral mass with vertebral osteomyelitis, and a positive biopsy culture for Aspergillus. Blood and CSF cultures were negative. [1]
COMMENT. Aspergillosis is a potential cause of myelopathy in immunosuppressed children treated with broad spectrum antibiotics.