Thoracic spondylitis from a mycotic (Streptococcus pneumoniae) aortic aneurysm: a case report.

Abstract:

STUDY DESIGN:We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described. SUMMARY OF BACKGROUND DATA:Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies. METHODS:The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 x 0.5 g/day, Cefotaxim 3 x 2 g/day, and Flucloxacillin 3 x 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter. RESULTS:The patient made a good recovery and is free of recurrence 4 years after surgery. CONCLUSIONS:Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Englert C,Aebert H,Lenhart M,Solleder A,Nerlich M,Neumann C

doi

10.1097/01.brs.0000137061.79898.8f

keywords:

subject

Has Abstract

pub_date

2004-09-01 00:00:00

pages

E373-5

issue

17

eissn

0362-2436

issn

1528-1159

pii

00007632-200409010-00026

journal_volume

29

pub_type

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