Limits...
Polymicrobial vertebral osteomyelitis after oesophageal biopsy: a case report.

Giger A, Yusuf E, Manuel O, Clerc O, Trampuz A - BMC Infect. Dis. (2016)

Bottom Line: He was treated with antibiotics and antifungal drugs and recovered fully.Vertebral osteomyelitis may be caused by direct spread following an oesophageal procedure.Microbiological diagnosis is essential to target the specific pathogen, especially in cases of polymicrobial infection.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. aude.giger@chuv.ch.

ABSTRACT

Background: While most cases of polymicrobial vertebral osteomyelitis are secondary to hematogenous seeding, direct inoculation during spinal surgery and contiguous spread from adjacent soft tissue are also potential routes whereby pathogens may infect the spine.

Case presentation: A 74 year-old man presented with an exacerbation of back pain after a fall. His past medical history included hepatocellular and oesophageal carcinoma. Three months earlier he had undergone an endoscopic biopsy of the oesophagus for routine follow-up of his oesophagus carcinoma. He also underwent a vertebroplasty due to suspected pathologic fracture. On admission to hospital, magnetic resonance imaging revealed an infiltrative process at the level of the 5th and 6th thoracic vertebrae. Blood cultures were positive for both Streptococcus mitis and Gemella morbillorum. During his course of antibiotic therapy he developed an abscess at the level of 8th thoracic vertebrae and culture of this abscess grew Candida albicans. He was treated with antibiotics and antifungal drugs and recovered fully.

Conclusion: Vertebral osteomyelitis may be caused by direct spread following an oesophageal procedure. Microbiological diagnosis is essential to target the specific pathogen, especially in cases of polymicrobial infection.

No MeSH data available.


Related in: MedlinePlus

Spine MRI shows improvement from earlier imaging, with decrease of epidural abcess and of medullary compression. Resolution of the abscess surrounding the site of cementoplasty as well as anterior abscess at the level of third thoracic to six thoracic and the soft tissue abcess
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4815082&req=5

Fig3: Spine MRI shows improvement from earlier imaging, with decrease of epidural abcess and of medullary compression. Resolution of the abscess surrounding the site of cementoplasty as well as anterior abscess at the level of third thoracic to six thoracic and the soft tissue abcess

Mentions: No surgical procedure was performed given the lack of neurological signs, and antibiotic treatment was continued. Clinical evolution was favourable and an MRI performed three weeks after initiation of antibiotic therapy showed regression of the epidural abscess (Fig. 3). Intravenous antibiotics were switched after six weeks to oral moxifloxacin (400 mg once daily), with a planned course of three months. Two days after initiation of oral antibiotic therapy the patient developed weakness of the right lower limb with progressive loss of sensation, extending to the left lower limb within 24 h. A CT of the spine revealed a new epidural abscess at the level of the 8th thoracic vertebra (Fig. 4). Intravenous ceftriaxone and metronidazole were reintroduced and a laminectomy at the 7th and 8th thoracic vertebra was immediately performed. The abscess was cultured and grew Candida albicans. Intravenous caspofungin was added and subsequently replaced by oral fluconazole (400 mg once daily) after two weeks. Metronidazole and ceftriaxone were switched to moxifloxacin after four weeks, and then to clindamycin due to a prolonged QT interval on the electrocardiogram. Therapy with clindamycin was maintained for three months and fluconazole for six months. The patient’s symptoms improved gradually, and an MRI performed twelve weeks after admission to our hospital revealed no residual abscess. At 6 month follow-up he had recovered almost fully, with only slight motor weakness of lower limbs.Fig. 3


Polymicrobial vertebral osteomyelitis after oesophageal biopsy: a case report.

Giger A, Yusuf E, Manuel O, Clerc O, Trampuz A - BMC Infect. Dis. (2016)

Spine MRI shows improvement from earlier imaging, with decrease of epidural abcess and of medullary compression. Resolution of the abscess surrounding the site of cementoplasty as well as anterior abscess at the level of third thoracic to six thoracic and the soft tissue abcess
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4815082&req=5

Fig3: Spine MRI shows improvement from earlier imaging, with decrease of epidural abcess and of medullary compression. Resolution of the abscess surrounding the site of cementoplasty as well as anterior abscess at the level of third thoracic to six thoracic and the soft tissue abcess
Mentions: No surgical procedure was performed given the lack of neurological signs, and antibiotic treatment was continued. Clinical evolution was favourable and an MRI performed three weeks after initiation of antibiotic therapy showed regression of the epidural abscess (Fig. 3). Intravenous antibiotics were switched after six weeks to oral moxifloxacin (400 mg once daily), with a planned course of three months. Two days after initiation of oral antibiotic therapy the patient developed weakness of the right lower limb with progressive loss of sensation, extending to the left lower limb within 24 h. A CT of the spine revealed a new epidural abscess at the level of the 8th thoracic vertebra (Fig. 4). Intravenous ceftriaxone and metronidazole were reintroduced and a laminectomy at the 7th and 8th thoracic vertebra was immediately performed. The abscess was cultured and grew Candida albicans. Intravenous caspofungin was added and subsequently replaced by oral fluconazole (400 mg once daily) after two weeks. Metronidazole and ceftriaxone were switched to moxifloxacin after four weeks, and then to clindamycin due to a prolonged QT interval on the electrocardiogram. Therapy with clindamycin was maintained for three months and fluconazole for six months. The patient’s symptoms improved gradually, and an MRI performed twelve weeks after admission to our hospital revealed no residual abscess. At 6 month follow-up he had recovered almost fully, with only slight motor weakness of lower limbs.Fig. 3

Bottom Line: He was treated with antibiotics and antifungal drugs and recovered fully.Vertebral osteomyelitis may be caused by direct spread following an oesophageal procedure.Microbiological diagnosis is essential to target the specific pathogen, especially in cases of polymicrobial infection.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. aude.giger@chuv.ch.

ABSTRACT

Background: While most cases of polymicrobial vertebral osteomyelitis are secondary to hematogenous seeding, direct inoculation during spinal surgery and contiguous spread from adjacent soft tissue are also potential routes whereby pathogens may infect the spine.

Case presentation: A 74 year-old man presented with an exacerbation of back pain after a fall. His past medical history included hepatocellular and oesophageal carcinoma. Three months earlier he had undergone an endoscopic biopsy of the oesophagus for routine follow-up of his oesophagus carcinoma. He also underwent a vertebroplasty due to suspected pathologic fracture. On admission to hospital, magnetic resonance imaging revealed an infiltrative process at the level of the 5th and 6th thoracic vertebrae. Blood cultures were positive for both Streptococcus mitis and Gemella morbillorum. During his course of antibiotic therapy he developed an abscess at the level of 8th thoracic vertebrae and culture of this abscess grew Candida albicans. He was treated with antibiotics and antifungal drugs and recovered fully.

Conclusion: Vertebral osteomyelitis may be caused by direct spread following an oesophageal procedure. Microbiological diagnosis is essential to target the specific pathogen, especially in cases of polymicrobial infection.

No MeSH data available.


Related in: MedlinePlus