Meningeal signs are rare, and at autopsy arachnoiditis is limited to the area adjacent to the cerebral focus. Cerebrospinal fluid shows a mild mononuclear pleocytosis, elevated CSF protein, and variable degrees of hypoglycorrhachia. Imaging studies demonstrate focal central nervous system lesions with edema and variable enhancement. The diagnosis can be established by the acute appearance of neurologic symptoms in a patient with proven or suspected invasive aspergillosis or occasionally by cerebrospinal fluid or brain biopsy culture. High-dose amphotericin B combined with flucytosine has been effective in a paucity of cases.
Epidural abscess is a rare complication of vertebral osteomyelitis caused by Aspergillus species.
In two children with epidural abscess, vertebral osteomyelitis and cord compression, surgical decompression, and high-dose amphotericin B were curative. Aspergillosis of the bone is an extremely rare disease and follows direct extension of infection from a surgical or traumatic wound or hematogenous seeding. Involvement of the vertebrae is most common. Osteomyelitis of the rib is rare, occurs in children with chronic granulomatous disease, and represents extension from a pulmonary focus. Surgical drainage is often required.