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Background   Aspergillus tubingensis  is a black  Aspergillus  belonging to the  Aspergillus  section  Nigri,  which includes species that morphologically resemble  Aspergillus niger . Recent developments in species determination have resulted in clinical isolates presumed to be  Aspergillus niger  being reclassified as  Aspergillus tubingensis  by sequencing .  We present a report of a patient with an osteomyelitis of the maxillary bone with a probable invasive  Aspergillus tubingensis  infection.    Case presentation  We describe an immune compromised patient suffering from osteomyelitis of the maxillary bone after tooth extraction. The osteomyelitis probably resulted in dentogenic pansinusitis presenting as an acute ethmoiditis. Histologic examination of biopsy samples showed osteomyelitis, and inflammation of the surrounding connective tissue. Cultures of the alveolar wound grew  Aspergillus tubingensis.  The patient was treated with liposomal amphoterocin B, which was changed to oral treatment with voriconazole based on susceptibility testing (MIC for voriconazole was 1 μg/ml).    Conclusion  This case shows that  Aspergillus tubingensis  may have the potential to cause severe invasive infections in immunocompromised hosts. A larger proportion of  Aspergillus tubingensis  isolates are less susceptible to azoles compared to  Aspergillus niger . Therefore, correct species identification and susceptibility testing is crucial for the choice of anti-fungal treatment, screening of azole resistance, and characterization of the pathogenic potential of the various species within  Aspergillus  section  Nigri.

Involvement of the opportunistic pathogen Aspergillus tubingensis in osteomyelitis of the maxillary bone: a case report