Multifocal spinal and extra‐spinal Mycobacterium chelonae osteomyelitis in a renal transplant recipient

Abstract

Only localized cases of Mycobacterium chelonae osteomyelitis have been reported. In this article, a 55-year-old immunosuppressed man with M. chelonae osteomyelitis and multiple spinal and extra-spinal involvement is presented. The patient had nodule-pustular skin lesions, spondylodiscitis at multiple levels, and osteolytic lesions at extra-spinal locations. Biopsy and cultures of the osseous lesions showed M. chelonae osteomyelitis. The patient started antimycobacterial chemotherapy with ciprofloxacin and clarithromycin. Progressive cervical kyphosis associated with anterior wedged deformity of the C5 vertebra and posterior C5-C6 spondylolisthesis resulted in compression of the spinal cord and neurological impairment. The patient underwent anterior decompression and C4-C6 arthrodesis using a titanium mesh cage and cervical plate. About 15 months after the initiation of chemotherapy and 5 months after surgery, the patient was pain free, with significant improvement of his neurological function. In the presence of immunosuppression, the physician should be alert for unusual or opportunistic pathogens of osteomyelitis. Long-term antimicrobial chemotherapy and surgical intervention is the cornerstone of successful treatment of multifocal bone M. chelonae infection.

When and how to operate on spondylodiscitis: a report of 13 patients

“…Additionally, if stable spinal reconstruction can be performed, bed rest and spinal immobilization with braces is minimized and rehabilitation is accelerated. Therefore, if adequate surgical debridement can be obtained and appropriate antibiotics administered, then spinal instrumentation should be performed for optimum spinal stability [15,[43][44][45].…”

Atypical Osteomyelitis Caused byMycobacterium chelonae—A Multimodal Imaging Approach

“…It is found in natural and processed water sources and known to be responsible for a distinct number of primary infections of the skin, lung, eyes, and soft tissue [2, 5–7]. …”

“…Bone and joint infections are extremely rare in the context of atypical mycobacterium infections [2]. …”

“…Osteomyelitis is mostly caused by staphylococcus aureus (75–80%), infrequently also by other bacteria, viruses, and funguses [2, 3]. …”

“…In the medical literature we found only 2 cases of Mycobacterium chelonae osteomyelitis visualized by multiple diagnostic imaging modalities [2, 4]. To our best knowledge SPECT/CT findings have not yet been published at all.…”