Lehman C R, Deckey J E, Hu S S
Spine Service, Department of Orthopedic Surgery, University of California at San Francisco, CA 94143, USA.
Spine (Phila Pa 1976). 2000 May 1;25(9):1185-7. doi: 10.1097/00007632-200005010-00022.
A case report.
To present a unique method of inoculation with an unusual bacterial organism, Eikenella corrodens, which led to vertebral osteomyelitis and to heighten awareness of different bacterial organisms that may cause orthopedic infections.
E. corrodens has been known to cause orthopedic infections for more than 20 years. The usual mechanism is from "Fight bite" injuries to the hand or metacarpal phalangeal joint. Eikenella osteomyelitis of the vertebral body is extremely rare.
A 65-year-old man from Indonesia developed slowly progressive vertebral collapse and worsening neck pain. History suggested a previous pharyngeal injury while eating fish. Work up for malignancy was negative, and imaging studies were suggestive of osteomyelitis. An open biopsy and culture as well as fusion were performed for treatment of the osteomyelitis.
After a complete work up was undertaken, cultures grew out E. corrodens as the causative organism of this patient's osteomyelitis. Computed tomography scan and history were consistent with inoculation of the paravertebral space with E. corrodens secondary to a fish bone transgressing the patient's pharynx. The patient was treated with surgery and the appropriate antibiotics and healed without any significant sequela.
Vertebral osteomyelitis due to E. corrodens is extremely rare. Direct inoculation as a cause of vertebral osteomyelitis with Eikenella has never been reported. If diagnosed properly with appropriate cultures and antibiotic sensitivities, Eikenella osteomyelitis can be treated successfully according to standard orthopedic practices including debridement, fusion, and appropriate antibiotics. Awareness of unusual bacteria as potential causative organisms of osteomyelitis is imperative for appropriate treatment.
病例报告。
介绍一种独特的接种方法，该方法涉及一种不常见的细菌——腐蚀埃肯菌，其导致了椎体骨髓炎，并提高对可能引起骨科感染的不同细菌的认识。
已知腐蚀埃肯菌可引起骨科感染已有20多年。常见机制是手部或掌指关节的“斗殴咬伤”。椎体的埃肯菌骨髓炎极为罕见。
一名65岁的印度尼西亚男子出现缓慢进展的椎体塌陷和颈部疼痛加重。病史提示既往吃鱼时咽部受伤。恶性肿瘤检查结果为阴性，影像学检查提示骨髓炎。为治疗骨髓炎进行了开放活检、培养及融合手术。
经过全面检查，培养结果显示腐蚀埃肯菌是该患者骨髓炎的致病菌。计算机断层扫描和病史与鱼骨穿过患者咽部继发腐蚀埃肯菌接种至椎旁间隙相符。患者接受了手术及适当的抗生素治疗，愈合良好，无明显后遗症。
腐蚀埃肯菌引起的椎体骨髓炎极为罕见。腐蚀埃肯菌作为椎体骨髓炎的直接接种原因从未有过报道。如果通过适当的培养和抗生素敏感性检测正确诊断，腐蚀埃肯菌骨髓炎可根据标准的骨科治疗方法成功治疗，包括清创、融合及适当的抗生素治疗。认识到不常见细菌作为骨髓炎潜在致病菌对于恰当治疗至关重要。
