Spinal epidural abscess caused by Aspergillus spp is a debilitating form of invasive aspergillosis that can easily be misdiagnosed as spinal tuberculosis due to shared risk factors and clinical features. In this Grand Round, we describe a case of thoracic aspergillus spinal epidural abscess in a patient with underlying HIV infection. The initial diagnostic consideration was that of spinal tuberculosis. Consequently, despite positive microbiological cultures of Aspergillus fumigatus, antifungal therapy was delayed until histopathological evaluation of the affected tissue confirmed the presence of fungal hyphae. The patient showed an initial favourable response after surgical removal of the infected focus, but unfortunately never returned to premorbid functioning. This case highlights the importance of early diagnosis, urgent surgery, and prompt antifungal therapy for the management of aspergillus spinal epidural abscesses. Associated morbidity and mortality can be substantially increased if physicians fail to recognise this condition and do not institute appropriate and timely surgical and medical treatment.

由曲霉属引起的脊髓硬膜外脓肿是侵袭性曲霉病的一种使人衰弱的形式，由于共同的危险因素和临床特征，很容易被误诊为脊柱结核。在本次 Grand Round 中，我们描述了一例潜在 HIV 感染患者的胸椎曲霉脊髓硬膜外脓肿病例。最初的诊断考虑是脊柱结核。因此，尽管烟曲霉的微生物培养呈阳性，抗真菌治疗被推迟，直到受影响组织的组织病理学评估证实真菌菌丝的存在。手术切除感染病灶后，患者最初表现出良好的反应，但不幸的是从未恢复到病前的功能。该病例强调了早期诊断、紧急手术和及时抗真菌治疗对治疗曲霉菌硬脊膜外脓肿的重要性。如果医生不能识别这种情况并且不采取适当和及时的手术和药物治疗，相关的发病率和死亡率可能会大大增加。