Vertebral osteomyelitis due to Staphylococcus lugdunensis

Abstract

We present the first reported case of vertebral osteomyelitis due to Staphylococcus lugdunensis. The infection occurred in an 80-year-old woman who had been taking glucocorticosteroids. S. lugdunensis is a coagulasenegative staphylococcus with considerable potential as a human pathogen. Isolation of this organism should be regarded as significant unless evidence suggests otherwise. Staphylococcus lugdunensis is a recently described coagulasenegative staphylococcus that forms part of the normal skin flora and has considerable potential as an opportunistic pathogen of humans (5, 7). Osteomyelitis caused by S. lugdunensis has been documented on only a few occasions and, when details have been provided, has been reported to complicate bone surgery (4, 7). In one series, this organism was associated with skull osteitis and wound infection following neurosurgery and was isolated from a knee joint and bone from another patient following orthopedic surgery (4). To our knowledge, the following is the first reported case of vertebral osteomyelitis due to S. lugdunensis. An 80-year-old woman presented with a 2-month history of back pain. This had come on suddenly and had been treated with analgesics for presumed degenerative disease. The pain had become more severe in the week prior to admission and radiated bilaterally to above the iliac crests. The only history of note was polymyalgia rheumatica, controlled with prednisone at 2.5 mg daily for over 2 years. Physical examination revealed fever (oral temperature, 38.2ЊC), poorly localized tenderness over the upper lumbar vertebrae, and reduced spinal movement, but no focal neurological deficits. There were no cardiac murmurs. Routine hematological testing showed a mild anemia (hemoglobin concentration, 113 g/liter), an elevated erythrocyte sedimentation rate of 105 mm/h, and a normal leukocyte count. The C-reactive protein was markedly elevated at 287 mg/liter (reference range, Ͻ10 mg/liter). Liver function tests

Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates

“…S. lugdunensis has been shown to cause meningitis secondary to ventriculo-peritoneal shunt infections, often with more extensive symptoms than those caused by other CoNS [7][8][9]. In addition, S. lugdunensis has been isolated from infections such as osteomyelitis [4,[10][11][12], pros-thetic joint infections [12,13], septic arthritis [14], skin and post-surgical wound infections [15,16], breast abscesses [17][18][19] and peritonitis associated with continuous ambulatory peritoneal dialysis [20].…”

Staphylococcus lugdunensis vertebral osteomyelitis

“…S. lugdunensis has also been associated with bacteremia [3], brain abscess [3], peritonitis [3], vascular prosthesis infection [3] and endocarditis [4]. It has only rarely been reported in association with bone and joint infections, and then either in immunocompromised patients [5], following arthroscopy [6] or associated with prosthetic joints [7]. Vertebral osteomyelitis secondary to S. lugdunensis was ®rst described in 1996 in an elderly woman undergoing long-term steroid treatment for polymyalgia rheumatica.…”

Development of antimicrobial resistance in Staphylococcus lugdunensis during treatment—report of a case of bacterial arthritis, vertebral osteomyelitis and infective endocarditis

“…Speci¢c virulence factors similar to those in S. aureus have not yet been identi¢ed, but toxins such as SLUSH [7,8], ãñae Concise Communications enzymes such as proteases, lipases and esterases, and glycocalyx have been reported [9]. The ¢rst case of vertebral osteomyelitis due to S. lugdunensis was reported in 1996 [10]. In that report, the patient was also being treated with corticosteroids, due to polymyalgia rheumatica, at the onset of symptoms.…”