Longitudinally extensive posterolateral myelitis revealing invasive CNS aspergillosis in an immunocompetent patient

Fungal infections of the central nervous system usually affect immunocompromised patients. Primary Aspergillus myelitis has never been described.

A 45-year-old immunocompetent male with subacute paraplegia was treated for inflammatory myelitis before clinical deterioration requiring mechanical ventilation. Purulent meningitis preceded the formation of a paraspinal nodule biopsied by neurosurgery. Histopathological analysis revealed the presence of fungal hyphae, and polymerase chain reaction was positive for Aspergillus fumigatus. No cause of immunodeficiency was identified in this patient.

Primary Aspergillus myelitis may be confused with inflammatory myelitis and should be considered even in the absence of apparent immunosuppression.