Kato Satoshi, Murakami Hideki, Demura Satoru, Yoshioka Katsuhito, Hayashi Hiroyuki, Yokogawa Noriaki, Fang Xiang, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
Case Rep Orthop. 2014;2014:197061. doi: 10.1155/2014/197061. Epub 2014 Dec 2.
Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.
脓肿分枝杆菌感染在健康个体中很少发生，主要发生在免疫功能低下的宿主中。由脓肿分枝杆菌引起的脊椎骨髓炎非常罕见，此前仅报道过3例由脓肿分枝杆菌引起的脊柱感染病例。脓肿分枝杆菌分离株对抗结核药物均耐药，并可表现出形成强毒生物膜的表型。该患者为一名67岁女性，患有L1-2椎体骨髓炎。她身体健康，无免疫抑制状况、外伤史或静脉吸毒史。经CT引导穿刺椎旁脓肿采集的标本涂片检查发现脓肿分枝杆菌。她的病情在使用抗菌化疗的保守治疗下并未减轻。对椎体骨髓炎进行了根治性清创，并使用含抗菌碘的器械从T12到L2进行了前路重建。术后使用克拉霉素、阿米卡星和亚胺培南进行化疗6个月，因为这些抗生素已被证明在术后对脓肿分枝杆菌有效。术后两年，感染的前部部位愈合，成功实现了骨融合，且无感染复发。
