Mycobacterium abscessus-associated vertebral osteomyelitis in an immunocompetent patient: a rare case report and literature review

Abstract

IntroductionVertebral osteomyelitis (VO) is an uncommon infection with Staphylococcus aureus as the most commonly implicated organism. VO caused by nontuberculous mycobacteria (NTM) such as Mycobacterium abscessus (M. abscesscus) is exceedingly rare with only eight cases reported in literature.Case presentationWe report a rare case of an 82-year-old male with a remote history of trauma who was diagnosed with NTM vertebral osteomyelitis. The patient initially underwent a vertebroplasty of T12 and kyphoplasty of L1 for pathologic compression fractures. Subsequent cultures revealed M. abscessus. The patient further underwent an anterior T12-L2 corpectomy and debridement with instrumented fusion, as well as a posterior T9-L4 instrumentation and fusion. He received multi-agent antibiotic therapy; however, was ultimately unable to tolerate the aggressive treatment regimen and his prolonged postoperative course.DiscussionNontuberculous mycobacteria vertebral osteomyelitis is exceedingly rare. NTM vertebral osteomyelitis is challenging to treat. Surgical management plays a limited role in early VO, but is the mainstay treatment in chronic VO. Early recognition of the condition and shared patient management with multidisciplinary teams is key to successfully treating cases of NTM VO.

Osteomyelitis of the spine: treatments and future directions

“…Posterior vertebral involvement is commonly seen in the cases of actinomycosis, coccidioidomycosis, and neoplasms [ 10 ]. VO is generally an indolent and slow growing disease with nonspecific clinical presentation [ 11 ]. The most common sites of involvement are the lumbar spine, which is greater than thoracic spine, and then followed by the cervical spine.…”

“…In cases of prolonged bacteremia, hematogenous VO due to low-virulence microorganisms has also been documented [ 4 ]. Other potential organisms include streptococci species, enterobacteriaceae, and enterococci [ 11 ]. Proteus Mirabalis , a rare cause of vertebral osteomyelitis, should be considered in the setting of recent urinary tract infection or urological surgery.…”

“…Vertebral Osteomyelitis with alternate pathogens may present in endemic regions and immunocompromised patients [ 3 ]. Mycobacterium Tuberculosis is a common cause of granulomatous VO in developing countries [ 11 ]. Other atypical organisms causing granulomatous VO include bacteria, fungal, and parasitic organisms.…”

“…Vertebral osteomyelitis (VO) presents as a challenging diagnosis for many clinicians because of its indolent and slow progression coupled with various nonspecific symptoms ranging from neck/back pain, malaise, night sweats, anemia, weight loss, fatigue, fever, spine deformity painful dorsal flexion, and contingently, neurological deficit that can become permanent [ 11 ]. An initial workup should include MRI and CT of the spine, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP), blood cultures, and an infectious disease workup.…”

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

“…Here, we reviewed 10 cases of vertebral osteomyelitis attributed to MA, [4] the majority of which occurred in immunocompromised patients (n = 6) and/or were from TB-epidemic/endemic areas. [5] Here, we report on a nonimmunocompromised 43-yearold female who developed L4-L5 spondylodiscitis attributed to MA following a relatively unrecognized form of lumbar disc management consisting of ozone therapy. [1]…”