An Unusual Case of Post-Operative Spondylitis Caused by Mycobacterium Intracellulare in an Immunosuppressed Patient.
10.3340/jkns.2011.50.5.460
- Author:
Sung Hoon KIM
1
;
Dong Wuk SON
;
Sang Weon LEE
;
Geun Sung SONG
Author Information
1. Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan Hospital, Yangsan, Korea. md6576@naver.com
- Publication Type:Case Report
- Keywords:
Post-operative spondylitis;
Mycobacterium intracellulare
- MeSH:
Aged;
Biopsy;
Blood Sedimentation;
C-Reactive Protein;
Epidural Abscess;
Female;
Fever;
Fractures, Compression;
Hematoma;
Humans;
Low Back Pain;
Magnetic Resonance Spectroscopy;
Multiple Organ Failure;
Mycobacterium;
Mycobacterium avium Complex;
Neurologic Manifestations;
Osteomyelitis;
Paraparesis;
Polymerase Chain Reaction;
Spinal Cord;
Spondylitis
- From:Journal of Korean Neurosurgical Society
2011;50(5):460-463
- CountryRepublic of Korea
- Language:English
-
Abstract:
There are few reported cases of post-operative spondylitis caused by Mycobacterium intracellulare. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, Mycobacterium intracellulare was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.
