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Vertebral Osteomyelitis


Presentation

  • This report presents a case of thoracic vertebral osteomyelitis with epidural abscesses due to A. nidulans in a 40-year-old immunocompetent female who presented with back pain, numbness and weakness of both lower limbs.[ncbi.nlm.nih.gov]
  • The protracted course and atypical presentation of osteomyelitis in diabetic adults can lead to major diagnostic delays.[ncbi.nlm.nih.gov]
  • To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome.[ncbi.nlm.nih.gov]
  • The third patient developed lumbar osteomyelitis following spinal surgery and presented with disseminated S. aureus sepsis including unilateral endogenous endophthalmitis.[ncbi.nlm.nih.gov]
  • The patient presented with acute urinary retention and flaccid paraplegia. Despite surgical debridement and treatment with voriconazole, the patient developed multiorgan failure and died two weeks after presentation.[ncbi.nlm.nih.gov]
Fever
  • Fever subsided soon after surgery and the patient continued antibiotics and remained free of fever at a 1-year follow-up. It can be challenging to diagnose vertebral osteomyelitis below injury levels in SCI patients.[ncbi.nlm.nih.gov]
  • Cat-scratch disease-associated vertebral osteomyelitis and epidural involvement are rare and may manifest with nonspecific chronic symptoms in children, such as fever or torticollis.[ncbi.nlm.nih.gov]
  • A 47-year-old man was investigated for fever, splenomegaly, and cervical adenopathy.[ncbi.nlm.nih.gov]
  • The independent risk factors for treatment failure were higher CRP levels [odds ratio (OR) 1.087; 95% confidence interval (CI): 1.025-1.153; p 0.005] and fever 37.8 C (OR 8.556; 95% CI: 2.273-32.207; p 0.002).[ncbi.nlm.nih.gov]
  • Rat-bite fever (RBF) is a challenging diagnosis transmitted by the bite of the rats. We present the first reported case of RBF complicated by vertebral osteomyelitis.[ncbi.nlm.nih.gov]
Malaise
  • In addition, there may be neurologic findings with radicular, meningeal or spinal-cord involvement. 1-3 The patient also may present with general fatigue, malaise and weight loss, and the back pain may be acute or chronic in nature.[dynamicchiropractic.com]
  • If any constitutional findings (eg, fever, malaise, weight loss) persist or if large areas of bone are destroyed, necrotic tissue is debrided surgically.[merckmanuals.com]
  • In these cases, symptoms were nonspecific, including back pain, fevers, productive cough, malaise, weight loss, and weakness.[journals.lww.com]
Cat Scratch
  • We report a 5-year-old boy with cat scratch disease who presented with painful torticollis and osteomyelitis of the cervical spine associated with an epidural abscess.[ncbi.nlm.nih.gov]
  • Cat-scratch disease-associated vertebral osteomyelitis and epidural involvement are rare and may manifest with nonspecific chronic symptoms in children, such as fever or torticollis.[ncbi.nlm.nih.gov]
  • To report cases of cat scratch disease with vertebral osteomyelitis.[ncbi.nlm.nih.gov]
Chronic Cough
  • We report a 4-year-old boy with chronic cough and kyphosis, who had a fungal vertebral osteomyelitis and Acinetobacter spp. paravertebral soft tissue infection related to X-linked chronic granulomatous disease.[ncbi.nlm.nih.gov]
Hepatomegaly
  • In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be[ncbi.nlm.nih.gov]
Back Pain
  • Despite persisting back pain, no recurrence of infection was seen at 3 years of follow-up. Lemierre syndrome and an extensive thoracolumbosacral vertebral osteomyelitis are rare but serious infections.[ncbi.nlm.nih.gov]
  • Case 2 is a 68-year-old woman who presented with upper back pain. Spine MRI revealed multiple lesions at T9-T12, L2, L4, and L5. Her back pain worsened, and repeated MRI revealed extensive bone lesions.[ncbi.nlm.nih.gov]
  • A low threshold for the consideration of infectious osteomyelitis is warranted in persons presenting with new, progressive back pain.[ncbi.nlm.nih.gov]
  • The patient returned with recurrent back pain 16 months after initial presentation. A. nidulans was identified by fungal culture and polymerase chain reaction.[ncbi.nlm.nih.gov]
  • The patient had no low back pain and both white blood cell count and C-reactive protein had remained normal.[ncbi.nlm.nih.gov]
Low Back Pain
  • A 65-year-old man presented with gradually exacerbating low back pain. Magnetic resonance imaging revealed vertebral osteomyelitis in the Th11-L2 vertebral bodies and discs. The patient showed negative findings on conventional cultures.[ncbi.nlm.nih.gov]
  • A 65-year-old man presented with low back pain and fever. He had a history of psoriasis vulgaris treated with adalimumab. The patient reported drinking adequate amounts of well water daily.[ncbi.nlm.nih.gov]
  • We discuss the case of a 67-year-old immunocompetent woman who presented with low back pain of 3 weeks duration associated with subjective fever and chills.[ncbi.nlm.nih.gov]
  • We report the first case of vertebral osteomyelitis caused by H. cinaedi in an elderly man with low back pain and fever.[ncbi.nlm.nih.gov]
  • The patient had no low back pain and both white blood cell count and C-reactive protein had remained normal.[ncbi.nlm.nih.gov]
Upper Back Pain
  • Case 2 is a 68-year-old woman who presented with upper back pain. Spine MRI revealed multiple lesions at T9-T12, L2, L4, and L5. Her back pain worsened, and repeated MRI revealed extensive bone lesions.[ncbi.nlm.nih.gov]
  • Case 2 is a 68-year-old woman who presented with upper back pain. Spine MRI revealed multiple lesions at T9–T12, L2, L4, and L5. Her back pain worsened, and repeated MRI revealed extensive bone lesions.[link.springer.com]
Paravertebral Muscle Spasm
  • Vertebral osteomyelitis causes localized back pain and tenderness with paravertebral muscle spasm that is unresponsive to conservative treatment.[merckmanuals.com]
Spine Pain
  • . - h/o of unremmiting spine pain at any level is characteristic, & tenderness, spasm, and loss of motion are seen; - initially onset of pain may be insidious; - w/ time, pain may be so severe that jarring the bed may be agonizing; - pain restricts ROM[wheelessonline.com]

Workup

  • This case demonstrates that early changes on MRI should warrant immediate workup and treatment. Treatment involves at least 6 weeks of parenteral antimicrobial therapy.[ncbi.nlm.nih.gov]
  • We present a case of an 83-year-old man, who had an F-18 FDG PET/CT scan for workup of a solitary pulmonary nodule, and was incidentally diagnosed with chronic multifocal infection of an aorto-iliac vascular graft, with an infected fistula tract into[ncbi.nlm.nih.gov]
  • While biopsy is an important part of the diagnostic workup of vertebral osteomyelitis, the microbiological yield was only 40-60% in previous studies [ 7, 16 ], similar to the 64% yield (28/44 bone cultures) in our study.[bmcinfectdis.biomedcentral.com]
  • If such symptoms are present, further diagnostic workup is immediately warranted.[physio-pedia.com]
Scedosporium
  • Fungal vertebral osteomyelitis due to Scedosporium apiospermum (S. apiospermum) is extremely rare.[ncbi.nlm.nih.gov]
Mycobacterium Chelonae
  • Mycobacterium chelonae is a rapidly growing mycobacterium (RGM) in Runyon group IV. This group includes all other nontuberculous mycobacterium (NTM) except the mycobacterium tuberculosis complex.[ncbi.nlm.nih.gov]

Treatment

  • After 3 months of antibiotic treatment, all enhanced lesions were diminished. An intramedullary spinal cord abscess is a rare but important complication of vertebral osteomyelitis, and it requires immediate treatment.[ncbi.nlm.nih.gov]
  • This case demonstrates that early changes on MRI should warrant immediate workup and treatment. Treatment involves at least 6 weeks of parenteral antimicrobial therapy.[ncbi.nlm.nih.gov]
  • INTERPRETATION: 6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment[ncbi.nlm.nih.gov]
  • We report a case of combined surgical and radiosurgical treatment of idiopathic vertebral osteomyelitis of L4.[ncbi.nlm.nih.gov]
  • RESULTS: Median antibiotic treatment was 8.1 weeks in 61 identified patients. Switch to oral antibiotics was performed in 72% of patients after a median intravenous therapy of 2.7 weeks.[ncbi.nlm.nih.gov]

Prognosis

  • Medical imaging techniques for vertebral osteomyelitis are a main focus, and treatment, prognosis, and possible complications also are discussed.[ncbi.nlm.nih.gov]
  • BACKGROUND: Hematogenous vertebral osteomyelitis (HVO) has a generally favorable prognosis if appropriate treatment is initiated in its early phase; however, some intractable cases with HVO can develop neurological impairment as well as spinal deformity[ncbi.nlm.nih.gov]
  • Patients may benefit from counseling regarding their disease type and potential prognosis. [Orthopedics. 2017; 40(2):e370-e373.]. Copyright 2016, SLACK Incorporated.[ncbi.nlm.nih.gov]
  • About this article Publication history Issue Date 01 October 2000 DOI Further reading Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis Alba Ribera, Maria Labori, Javier Hernández, Jaime Lora-Tamayo, Lluís[nature.com]
  • Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae. [5] The prognosis for the disease is dependent on where the infection is concentrated in the spine[en.wikipedia.org]

Etiology

  • Abstract Vertebral osteomyelitis is known to occur in chronic granulomatous disease, a phagocytic disorder and the etiology is usually a fungus.[ncbi.nlm.nih.gov]
  • Elevated laboratory values such as erythrocyte sedimentation rate and C-reactive protein suggest inflammatory etiologies.[ncbi.nlm.nih.gov]
  • A 53-year-old male patient was found to have lesions on lumbar vertebra 5 months after thoracoscopic resection of pulmonary granuloma that lacked a definite etiology.[ncbi.nlm.nih.gov]
  • This case suggests that Salmonella should be considered as an etiologic pathogen in adult patients with perivertebral infection or meningitis.[ncbi.nlm.nih.gov]
  • SVO is really rare and it alerts us the importance to consider uncommon pathogens in the differential diagnosis in which the etiological evidences are crucial of healthy individuals.[ncbi.nlm.nih.gov]

Epidemiology

  • Overall, VO in OLT patients was more difficult to diagnose as a result of altered inflammation response and specific microbial epidemiology of causal microorganisms. Copyright 2015 European Society of Clinical Microbiology and Infectious Diseases.[ncbi.nlm.nih.gov]
  • Lebanon. 3 Division of Infectious Diseases, Gundersen Health System, La Crosse, Wisconsin. 4 Section of Infectious Diseases and Center for Prostheses Infection, Baylor College of Medicine, Houston, Texas. 5 Division of Infectious Diseases, Hospital of Epidemiology[ncbi.nlm.nih.gov]
  • If clinical or epidemiological evidence points to the need, blood cultures and serological tests for Brucella or fungi may be indicated.[ahcmedia.com]
  • Cornely Mycoses. 2013; : n/a 3 Aspergillus osteomyelitis: Epidemiology, clinical manifestations, management, and outcome Maria N. Gamaletsou,Blandine Rammaert,Marimelle A. Bueno,Brad Moriyama,Nikolaos V. Sipsas,Dimitrios P.[neurologyindia.com]
  • Epidemiology 1 to 2.4 cases per 100,000 people ( Zimmerli 2010 ) More common in males with M:F of 3:1 Rate is also increasing due to increased number of spinal procedures Typically affects adults, with most cases occurring in patients over 50 years old[coreem.net]
Sex distribution
Age distribution

Pathophysiology

  • Contents References 125 Diagnosis of Circulatory Disorders 129 52 Pathophysiology 130 54 Distinctive Forms of Osteonecrosis 132 References 141 Neoplastic Bone Diseases 143 62 Pathophysiology 144 63 Scintigraphy of Primary Bone Tumors 154 64 Scintigraphy[books.google.com]
  • […] cervical spine risk factors include IV drug abuse diabetes recent systemic infection (UTI, pneumonia) obesity malignancy immunodeficiency or immunosuppressive medications malnutrition (serum albumin 3 g/dL indicative of malnutrition) trauma smoking Pathophysiology[orthobullets.com]
  • Mycobacterium tuberculosis Pathophysiology Most cases of osteomyelitis secondary to Mycobacterium tuberculosis are hematogenous in origin, often from a pulmonary source; however, contiguous spread from adjacent structures is possible. 1 After seeding[journals.lww.com]
  • Pathophysiology • Approximately 95% of pyogenic spinal infections involve the vertebral body, and only 5% involve the posterior elements of the spine.[de.slideshare.net]
  • Neuroradiol Scan 2016; 06(03): 215-238 DOI: 10.1055/s-0042-109937 Georg Thieme Verlag KG Stuttgart · New York Spinal neuroarthropathy: pathophysiology, clinical and imaging features, and differential diagnosis Weitere Informationen Publikationsverlauf[thieme-connect.com]

Prevention

  • Prompt diagnosis of MAC vertebral osteomyelitis is challenging, but necessary to prevent serious morbidity or mortality.[ncbi.nlm.nih.gov]
  • PLD can be used to resect diseased discs to relieve pain quickly and to prevent herniation of lumbar discs. After PLD, external drainage can be employed for abscess drainage, decompression and perfusion of antibiotics.[ncbi.nlm.nih.gov]
  • CONCLUSIONS In this case, multiple weekly dalbavancin infusions appeared to be safe in the treatment of vertebral osteomyelitis caused by MRSA, but did not seem to prevent infection recurrence.[ncbi.nlm.nih.gov]
  • Therapy can be geared toward the specific pathogen cultured, thereby preventing the need surgical intervention in the majority of cases.[ncbi.nlm.nih.gov]
  • “Early diagnosis and appropriate management can prevent disability, so a high index of suspicion and early ID consultation are central to a good outcome.”[idsociety.org]

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