Mycobacterium abscessus mimicking tubercular spondylodiscitis following ozone therapy: A case report and review of literature

Abstract

Background: The incidence of Mycobacterium abscessus (MA), a rapidly growing species of nontuberculous mycobacteria (NTM)-related infections, has been steadily rising over the past decade. Despite the increased prevalence of NTM-related infections, it is largely underreported from TB-endemic countries due to lack of awareness and limited laboratory facilities. Here, we report a rare case of L4–L5 spondylodiscitis caused by MA following ozone therapy (a noncondoned method of lumbar disc management). Case Description: A healthy, nonimmunocompromised 43-year-old female presented with bilateral lower extremity radiculopathy. She underwent a fluoroscopically guided percutaneous ozone treatment for degenerated disc disease at the L4–L5 level. She was symptom free for 3 months duration. She then presented with severe low back pain, bilateral lower extremity radiculopathy, and spondylodiscitis at the L4–L5 level. This was treated with a L4–L5 transforaminal lumbar interbody fusion. MA was cultured from the epidural purulent material collected during the surgery. The patient was discharged on oral clarithromycin 500 mg twice daily and intravenous amikacin 500 mg twice daily for 6 weeks. The plan was to then continue oral clarithromycin for another 6 weeks till resolution of primary infection. Conclusion: Early diagnosis and appropriate therapy is required to treat NTM which is more prevalent in epidemic/endemic regions.

Serious spondylodiscitis, septic sacroiliitis and multiple abscesses after ozone therapy for low back pain: A case report on good response to combined treatment with empiric antibiotic and neridronate

“…Currently, spondylodiscitis caused by ozone therapy has been described only in 4 cases in the literature 3–6 . Bo et al described a case of C3–C4 pyogenic discitis with associated spinal epidural abscess (SEA) which caused rapid neurologic deterioration including respiratory dysfunction.…”

“…For fluid collection in the wound, she was treated after 6 weeks with intravenous amikacin 500 mg twice daily for 6 weeks, supplemented with oral clarithromycin 500 mg twice daily. Subsequently, she was continued on oral clarithromycin for another 6 weeks following the resolution of the primary infection 3 …”

“…Subsequently, she was continued on oral clarithromycin for another 6 weeks following the resolution of the primary infection. 3 As regarding other rare but fearful complications of ozone therapy, Gazzeri et al reported a case of fatal fulminating septicemia secondary to Escherichia coli infection after oxygen-ozone therapy for lumbar disc herniation, in which a pyogenic lumbar muscle involvement, acute bilateral lobar pneumonia, and septic pulmonary embolism were present. 7 Antibiotic therapy is a pillar of treatment for spondylodiscitis; however, some complications can occur and require surgical debridement and stabilization.…”