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Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation.

Kato S, Murakami H, Demura S, Yoshioka K, Hayashi H, Yokogawa N, Fang X, Tsuchiya H - Case Rep Orthop (2014)

Bottom Line: Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy.Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery.Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan.

ABSTRACT
Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

No MeSH data available.


Related in: MedlinePlus

Enhanced T1-weighted magnetic resonance imaging showing vertebral osteomyelitis which involved the L1 and L2 vertebral bodies. (a) Sagittal view. (b) Axial view.
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fig1: Enhanced T1-weighted magnetic resonance imaging showing vertebral osteomyelitis which involved the L1 and L2 vertebral bodies. (a) Sagittal view. (b) Axial view.

Mentions: A 67-year-old woman, with compensated hypothyroidism and hypertension, presented to another hospital with continuous low back pain and a low-grade fever of 3-month duration. She was diagnosed with subacute thyroiditis and treated accordingly; however, her symptoms did not abate. Computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine revealed destructive changes of the L1 and L2 vertebral bodies; these changes were surrounded by paravertebral abscesses (Figure 1). A culture examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed nontuberculous mycobacteria identified as Mycobacterium abscessus, which were noted to be resistant to antituberculous agents in vitro. The patient's pain level and spinal destruction gradually advanced. Additionally, there was a continuous discharge of pus from the puncture hole despite chemotherapy treatment with ethambutol, rifampicin, and isoniazid. The patient presented to our hospital 6 weeks after the diagnosis.


Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation.

Kato S, Murakami H, Demura S, Yoshioka K, Hayashi H, Yokogawa N, Fang X, Tsuchiya H - Case Rep Orthop (2014)

Enhanced T1-weighted magnetic resonance imaging showing vertebral osteomyelitis which involved the L1 and L2 vertebral bodies. (a) Sagittal view. (b) Axial view.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269211&req=5

fig1: Enhanced T1-weighted magnetic resonance imaging showing vertebral osteomyelitis which involved the L1 and L2 vertebral bodies. (a) Sagittal view. (b) Axial view.
Mentions: A 67-year-old woman, with compensated hypothyroidism and hypertension, presented to another hospital with continuous low back pain and a low-grade fever of 3-month duration. She was diagnosed with subacute thyroiditis and treated accordingly; however, her symptoms did not abate. Computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine revealed destructive changes of the L1 and L2 vertebral bodies; these changes were surrounded by paravertebral abscesses (Figure 1). A culture examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed nontuberculous mycobacteria identified as Mycobacterium abscessus, which were noted to be resistant to antituberculous agents in vitro. The patient's pain level and spinal destruction gradually advanced. Additionally, there was a continuous discharge of pus from the puncture hole despite chemotherapy treatment with ethambutol, rifampicin, and isoniazid. The patient presented to our hospital 6 weeks after the diagnosis.

Bottom Line: Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy.Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery.Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan.

ABSTRACT
Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

No MeSH data available.


Related in: MedlinePlus