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Thoracic spinal osteomyelitis due to Salmonella enteritidis in an immunocompetent mimicking tuberculosis.

Lakshmi K, Santhanam R - J Neurosci Rural Pract (2016 Apr-Jun)

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India.

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The routinely followed practice in cases of infective spondylitis without instability is to start empirical antitubercular therapy where the clinical picture, radiological, and magnetic resonance imaging (MRI) findings resemble the tuberculosis infection of the spine, although tissue biopsy and culture are done in some cases to confirm the diagnosis... Here, we report a case of spinal infection in a healthy middle-aged immunocompetent man, in whom the clinical findings and the radiological images were similar to tuberculous infection and were misdiagnosed as tuberculous spondylitis on admission and later on, the biopsy and culture of the decompressed specimen surprisingly turned out to be Salmonella osteomyelitis... The laboratory tests revealed C-reactive protein (CRP) of 9.6 mg/L and erythrocyte sedimentation rate (ESR) was 50 mm/h... MRI study showed D7-D8 Spondylodiscitis associated with small pre- and para-vertebral, anterior epidural space abscess [Figures 1 and 2]... An empirical diagnosis of tuberculosis spine (Dorsal spondylitis) was made, and he was started on antituberculous treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol... Computed tomography-guided biopsy done at initial evaluation was inconclusive and showed scanty nonspecific inflammatory cells only... Blood culture was negative... Postoperatively, tests for hemoglobinopathy were done and found to be negative... Salmonella osteomyelitis has been reported in patients with sickle cell disease where sickling occurring in the intestine may lead to the passage of the Salmonella in the gut flora into the blood stream and finally reaching the bone causing infection... However, Salmonella is unusual in patients who have neither sickle cell disease nor who are immunocompromised... It is very difficult to differentiate Salmonella and tuberculous spondylitis as both have similar clinicoradiological and epidemiological findings... Furthermore, as tuberculosis of spine is very common in our country, a provisional diagnosis of tuberculosis was made, and empirical antitubercular therapy was initiated and continued until the biopsy report proved it to be Salmonella infection... The prevalent practice of empirical antituberculous treatment for spinal infections in regions endemic for tuberculosis cannot be considered scientific... Tissue biopsy and culture must be obtained in all cases of spinal infections... There are no conflicts of interest.

No MeSH data available.


Postoperative X-ray dorsal spine lateral view showing D6-D9 fusion
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Figure 3: Postoperative X-ray dorsal spine lateral view showing D6-D9 fusion

Mentions: An empirical diagnosis of tuberculosis spine (Dorsal spondylitis) was made, and he was started on antituberculous treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol. Computed tomography-guided biopsy done at initial evaluation was inconclusive and showed scanty nonspecific inflammatory cells only. Subsequently, after a few days, as he had severe pain not responding to conservative measures, he was subjected to left posterolateral thoracotomy, D7 D8 corpectomy, and D6-D9 fusion with titanium cage packed with cancellous bone graft, rods, and screws [Figure 3]. Intercostal drainage tube was maintained for 3 days and was removed after ensuring good lung expansion. Postoperatively, his pain was relieved, and he made uneventful recovery.


Thoracic spinal osteomyelitis due to Salmonella enteritidis in an immunocompetent mimicking tuberculosis.

Lakshmi K, Santhanam R - J Neurosci Rural Pract (2016 Apr-Jun)

Postoperative X-ray dorsal spine lateral view showing D6-D9 fusion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4821952&req=5

Figure 3: Postoperative X-ray dorsal spine lateral view showing D6-D9 fusion
Mentions: An empirical diagnosis of tuberculosis spine (Dorsal spondylitis) was made, and he was started on antituberculous treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol. Computed tomography-guided biopsy done at initial evaluation was inconclusive and showed scanty nonspecific inflammatory cells only. Subsequently, after a few days, as he had severe pain not responding to conservative measures, he was subjected to left posterolateral thoracotomy, D7 D8 corpectomy, and D6-D9 fusion with titanium cage packed with cancellous bone graft, rods, and screws [Figure 3]. Intercostal drainage tube was maintained for 3 days and was removed after ensuring good lung expansion. Postoperatively, his pain was relieved, and he made uneventful recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The routinely followed practice in cases of infective spondylitis without instability is to start empirical antitubercular therapy where the clinical picture, radiological, and magnetic resonance imaging (MRI) findings resemble the tuberculosis infection of the spine, although tissue biopsy and culture are done in some cases to confirm the diagnosis... Here, we report a case of spinal infection in a healthy middle-aged immunocompetent man, in whom the clinical findings and the radiological images were similar to tuberculous infection and were misdiagnosed as tuberculous spondylitis on admission and later on, the biopsy and culture of the decompressed specimen surprisingly turned out to be Salmonella osteomyelitis... The laboratory tests revealed C-reactive protein (CRP) of 9.6 mg/L and erythrocyte sedimentation rate (ESR) was 50 mm/h... MRI study showed D7-D8 Spondylodiscitis associated with small pre- and para-vertebral, anterior epidural space abscess [Figures 1 and 2]... An empirical diagnosis of tuberculosis spine (Dorsal spondylitis) was made, and he was started on antituberculous treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol... Computed tomography-guided biopsy done at initial evaluation was inconclusive and showed scanty nonspecific inflammatory cells only... Blood culture was negative... Postoperatively, tests for hemoglobinopathy were done and found to be negative... Salmonella osteomyelitis has been reported in patients with sickle cell disease where sickling occurring in the intestine may lead to the passage of the Salmonella in the gut flora into the blood stream and finally reaching the bone causing infection... However, Salmonella is unusual in patients who have neither sickle cell disease nor who are immunocompromised... It is very difficult to differentiate Salmonella and tuberculous spondylitis as both have similar clinicoradiological and epidemiological findings... Furthermore, as tuberculosis of spine is very common in our country, a provisional diagnosis of tuberculosis was made, and empirical antitubercular therapy was initiated and continued until the biopsy report proved it to be Salmonella infection... The prevalent practice of empirical antituberculous treatment for spinal infections in regions endemic for tuberculosis cannot be considered scientific... Tissue biopsy and culture must be obtained in all cases of spinal infections... There are no conflicts of interest.

No MeSH data available.