Aspergillus-related myositis: a case report and review of the literature

Abstract

Objectives: Infectious myositis can be a life-threatening condition. We describe the clinical presentation, diagnosis, treatment, and outcome of a patient with Aspergillus-related myositis and review the relevant literature on Aspergillus-related myositis.

Methods: We report on a patient with acquired immunodeficiency syndrome who presented with Aspergillus myo-fasciitis, which was unusual because of its relapsing-remitting course and favorable outcome. We analyze the clinical features, diagnosis, and treatment of 9 additional patients identified through a PubMed literature review between 1964 and early 2010.

Results: A 64-year-old human immunodeficiency virus positive African woman was hospitalized for a relapsing-remitting history of bilateral myo-fasciitis for more than 15 years. She had already undergone 3 previous muscle biopsies without definite diagnosis. A computed tomographic scan-guided biopsy revealed numerous septae hyphae with focal necrosis. Cultures yielded Aspergillus flavus as the underlying pathogen and the diagnosis of Aspergillus-related myo-fasciitis was finally made. On reviewing the literature, only 9 other cases have been described. However, no similar case with such a chronic and favorable course was reported.

Conclusions: As compared with the reported cases in the literature, our case is unusual because of its relapsing-remitting course for more than 15 years and favorable outcome. Our case emphasizes the difficulty of the diagnosis, and the importance of early and appropriate management of this rare myositis, which should be systematically evoked in patients with immune deficiency.