Disseminated Aspergillus flavus infection presenting as spondylodiscitis: a fatal tuberculosis mimicker in an immunocompetent host – case report and literature review

The article describes a rare case of disseminated invasive aspergillosis caused by Aspergillus flavus in a 54-year-old man with no known immunosuppression. The patient suffered from a five-month progressive back pain with lower limb paresis. Imaging studies revealed inflammation between vertebrae with abscess in the epidural space. Initial histopathological analysis incorrectly suggested tuberculosis infection, leading to antituberculous medication. Subsequently, fungal culture and specific staining identified Aspergillus flavus infection. The patient was treated with antifungal medications, first amphotericin B and later voriconazole. Despite treatment, progressive neurological deterioration occurred and the patient died after surgery. The case emphasizes the need to consider aspergillosis in the differential diagnosis of chronic spondylodiscitis even in apparently immunocompetent patients.