Paraspinal Scedosporium Infection in an Immunocompetent Adult

Background: Scedosporium species are rare opportunistic fungi that predominantly affect immunocompromised individuals. Soft tissue infections in immunocompetent hosts are uncommon and often pose significant diagnostic and therapeutic challenges due to nonspecific clinical and radiologic features. Case Presentation: We report the case of a 53-year-old immunocompetent woman who presented with a 15-day history of progressive low back pain radiating to the left buttock, initially without swelling or systemic symptoms. The patient was initially misdiagnosed and treated conservatively. Subsequent development of localized swelling prompted imaging (ultrasound), which revealed a paraspinal abscess. Incision and drainage yielded purulent material, and microbiological culture identified Scedosporium species. Imaging (CECT scan) confirmed a paraspinal collection extending from L2 to S3 without deeper extension. The patient was treated with voriconazole, but premature discontinuation due to adverse effects led to disease recurrence. Repeat imaging (ultrasound) and biopsy showed inflammatory and granulomatous changes, with tuberculosis excluded through interferon-gamma release assay. Following reinitiation and completion of a prolonged course of voriconazole, the patient achieved complete clinical resolution. Conclusion: This case highlights an unusual presentation of paraspinal Scedosporium infection in an immunocompetent host, emphasizing the importance of considering rare fungal pathogens in persistent musculoskeletal infections with granulomatous inflammation. Early microbiological diagnosis, awareness of antifungal toxicity, and completion of an adequate treatment duration are crucial to prevent recurrence and ensure favorable outcomes.