Spinal Osteomyelitis due to Mycobacterium avium-intracellulare in an Elderly Man with Steroid-induced Osteoporosis

Pirofsky, Jeffry G.; Huang, Chi-Tsou; Waites, Ken B.

doi:10.1097/00007632-199310000-00036

Cited by 32 publications

(22 citation statements)

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“…5 Pirofsky et al reported an elderly patient who underwent steroid therapy for SLE and developed lower thoracic vertebral osteomyelitis caused by Mycobacterium tuberculosis. 3 Pruitt et al presented the case of a SLE patient with steroid-dependent thoracic vertebral osteomyelitis secondary to Mycobacterium chelonae subspecies abscess. 4 In the present case, we operated for correction of angulation and for histopathological diagnosis using an anterior cervical approach, and performed C5-C6 discectomy, debridement and graftings.…”

Section: Discussionmentioning

confidence: 99%

“…Tuberculous spondylitis very rarely occurs in SLE patients. 1,3,4 Case report A 54-year-old female patient was admitted to our hospital with a complaint of neck pain radiating to her shoulder of 2 months' duration. The neurological examination was completely normal and radiological investigations revealed narrowing, angulation and destruction of the end plates of the 5th and 6th cervical vertebrae (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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Cervical tuberculous spondylitis associated with systemic lupus erythematosus

et al. 2001

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Study design: A case report of cervical tuberculous spondylitis associated with systemic lupus erythematosus (SLE). Infection is a frequent problem in SLE, especially in patients hospitalised with the complications of the disease. Tuberculous spondylitis very rarely occurs in SLE patients, and cervical involvement has not been previously reported. Case report: A 54-year-old female patient was admitted to our hospital with a complaint of neck pain radiating to her shoulder of 2 months' duration. The neurological examination was completely normal and radiological investigations revealed narrowing, angulation and destruction of the end plates of the 5th and 6th cervical vertebrae. She has received corticosteroid and colchicine treatment for the diagnosis of SLE during the last 10 years. The anterior cervical approach was used and pyogenic material was debrided from the C5-6 intervertebral space, and an otogenous bone graft with a Smith Robinson type fusion was performed. Conclusion: High doses of corticosteroids are implicated as a risk factor for infection in SLE patients. Early diagnosis and appropriate medical and surgical treatment, as well as increased awareness of higher susceptibility to opportunistic infections, such as tuberculous spondylitis, are keystones for decreasing morbidity and mortality in patients with SLE. Spinal Cord (2001) 39, 549 ± 553

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cervical tuberculous spondylitis associated with systemic lupus erythematosus

et al. 2001

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“…8 MAC has a long incubation period; it usually takes more than 6 weeks to grow, which often delays diagnosis. 9 Sputum smears are a less reliable means of diagnosing MAC than tuberculosis. 6 Specimens from sputum and pleural fluid were reportedly negative in one study.…”

Section: Gib Denotes Gastrointestinal Bleedingmentioning

confidence: 99%

“…6 Specimens from sputum and pleural fluid were reportedly negative in one study. 9 It is recommended that biopsies (needle or open or image-guided) to obtain tissue or bony specimens are used for diagnosing MAC spinal infection. 7,9,10 Cutaneous and blood tests are not useful for diagnosis and differentiation from other infections.…”

Section: Gib Denotes Gastrointestinal Bleedingmentioning

confidence: 99%

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Spinal Infection Caused by Mycobacterium Avium Complex in a Patient with No Acquired Immune Deficiency Syndrome: A Case Report

Wong

Sun

Lau

2008

J Orthop Surg (Hong Kong)

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Spinal infection caused by Mycobacterium avium complex (MAC) is rarely seen in people who do not have acquired immune deficiency syndrome. We report such a case in a 60-year-old man who underwent anterior spinal fusion after treatment with antibiotics had failed. The presentation of MAC spinal infection is different from that seen in MAC lung infection, with more than half presenting with urgent or semi-urgent neurological deficits. Younger patients who are not immunocompromised can also be infected. It should be considered as a differential diagnosis in patients with tuberculosis of the spine. The use of antibiotics should be based on the cultured organism's sensitivity results. Indications for surgery are progressive bony destruction, abscess formation, and neurological compression. CASE REPORTIn March 2004, a 60-year-old man presented to our hospital with a 6-month history of back pain, unrelated to any trauma. Two years earlier, one of his fingers became infected and the culture grew Proteus, Staphylococcus aureus, and Serratia. The finger was partially amputated and the wound healed eventually.He was hypertensive and had gout but was not diabetic, immunocompromised or using steroids. A physical examination found diffuse tenderness over the mid-lumbar region but no other signs suggestive of neurological involvement. He was afebrile and had a negative psoas sign. Radiographs revealed erosion of the lower endplate of L2 and upper endplate of L3 vertebral bodies (Fig. 1). The psoas shadows were not noticeably increased on both sides. Blood tests showed a raised erythrocyte sedimentation rate of 44 mm/hr and a C-reactive protein level of 16 mg/l with a normal white cell count. The white cell differential counts were within normal ranges (neutrophil count, 5.2 x10 9 /l; lymphocyte count, 1.6 x10 9 /l). The fasting blood sugar was 5.4 mmol/l. The renal and liver

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Atypical mycobacterial spondylitis as a challenging differential diagnosis to metastatic disease of the spine: a case report

Wang

Shang

Huang

et al. 2012

Eur J Orthop Surg Traumatol

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Disseminated Mycobacterium avium complex (MAC) infection is rarely seen in patients without acquired immune deficiency syndrome. A disseminated MAC infection presenting with symptoms that mimic tumor metastasis had not previously been reported. Few disseminated MAC infections have been reported, and all image patterns in these cases indicated destructive lesions. We present a case involving a tumor-like disseminated MAC infection with spondylitis in a 68-year-old man whose symptoms started with severe lower back pain and fever. Treatment for malignancy was performed initially but soon stopped after tissue proving MAC infection. Symptoms then improved dramatically after a four-drug combined anti-nontuberculous mycobacteria treatment.

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Spinal Osteomyelitis due to Mycobacterium avium-intracellulare in an Elderly Man with Steroid-induced Osteoporosis

Cited by 32 publications

References 0 publications

Cervical tuberculous spondylitis associated with systemic lupus erythematosus

Cervical tuberculous spondylitis associated with systemic lupus erythematosus

Spinal Infection Caused by Mycobacterium Avium Complex in a Patient with No Acquired Immune Deficiency Syndrome: A Case Report

Atypical mycobacterial spondylitis as a challenging differential diagnosis to metastatic disease of the spine: a case report

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