Patel Prakashchandra, Olive Kenneth E, Krishnan Koyamangalath
Division of Hematology-Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN 37614, USA.
South Med J. 2003 Jul;96(7):692-5. doi: 10.1097/01.SMJ.0000052061.64660.B8.
A 65-year-old man with a 3-month history of intractable back pain had previously received cytotoxic curative chemotherapy for non-Hodgkin's lymphoma. His postchemotherapy course had been complicated by febrile neutropenia, recurrent coagulase-negative staphylococcal bacteremia, and gastrostomy site infections. He was admitted with severe intractable lower back pain requiring high doses of intravenous narcotic analgesia. Magnetic resonance imaging of the spine was highly suggestive of disk infection. Fluoroscopically guided needle aspiration of the disk space was confirmatory, and both tissue and blood cultures were positive for coagulase-negative Staphylococcus species. Treatment included i.v. vancomycin and oral levofloxacin. The most common organism causing disk space infection is Staphylococcus aureus. but Staphylococcus epidermis should be considered in immunocompromised patients. Septic discitis is an important differential diagnosis of back pain and should be considered in any clinical situation associated with bacteremia.
一名65岁男性，有3个月顽固性背痛病史，此前因非霍奇金淋巴瘤接受了细胞毒性根治性化疗。他化疗后的病程出现了发热性中性粒细胞减少、复发性凝固酶阴性葡萄球菌菌血症和胃造口部位感染等并发症。他因严重顽固性下背痛入院，需要大剂量静脉注射麻醉性镇痛药。脊柱磁共振成像高度提示椎间盘感染。在荧光镜引导下对椎间盘间隙进行针吸活检得到了确诊，组织和血培养凝固酶阴性葡萄球菌均呈阳性。治疗包括静脉注射万古霉素和口服左氧氟沙星。引起椎间盘间隙感染最常见的病原体是金黄色葡萄球菌，但对于免疫功能低下的患者，应考虑表皮葡萄球菌。化脓性椎间盘炎是背痛的重要鉴别诊断，在任何与菌血症相关的临床情况下都应予以考虑。
