Quast Michaela B, Carr Carrie M, Hooten W Michael
Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA.
Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA.
J Med Case Rep. 2017 Nov 22;11(1):328. doi: 10.1186/s13256-017-1492-z.
Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has not been previously reported. Here we provide a case report of a multilevel lumbar spine infection that developed in an immunocompetent adult with poor dentition.
A 63-year-old white male man with past medical history of hypertension presented to a hospital emergency department with a 4-month history of progressively worsening low back pain. A musculoskeletal examination demonstrated diffuse tenderness in his lumbar spine area and the results of a neurological examination were within normal limits. Computed tomography and magnetic resonance imaging of his lumbar spine demonstrated a prevertebral and presacral fluid collection ventral to the L4 to L5 and L5 to S1 interspaces. Blood cultures grew pan-sensitive Streptococcus intermedius in four of four bottles within 45 hours. Using computed tomography guidance, three core biopsies of the L4 to L5 interspace were taken and subsequent cultures were positive for Streptococcus intermedius. He reported that his last episode of dental care occurred more than 20 years ago and a dental panoramic radiograph demonstrated significant necrotic dentition. Ten teeth were extracted and the necrotic dentition was assumed to be the most likely source of infection. On hospital dismissal, he received a 12-week course of intravenously administered ceftriaxone followed by an 8-week course of orally administered cefadroxil pending repeat imaging.
This case report demonstrates the importance of determining the source of infection in a patient with a spontaneous spinal infection. Even in the absence of a recent dental procedure, dentition should be considered a possible source of infection in an immunocompetent patient who presents with a spontaneous spinal infection.
尽管已有牙科手术后发生脊柱感染的报道，但在免疫功能正常的成年人中，无牙科手术史却因牙列不佳导致脊柱感染的情况此前尚未见报道。在此，我们报告一例免疫功能正常、牙列不佳的成年人发生多节段腰椎感染的病例。
一名63岁有高血压病史的白人男性因4个月来逐渐加重的下背痛就诊于医院急诊科。肌肉骨骼检查显示其腰椎区域弥漫性压痛，神经系统检查结果正常。腰椎计算机断层扫描（CT）和磁共振成像（MRI）显示，在L4至L5和L5至S1椎间隙前方有椎前和骶前液体积聚。血培养在45小时内四个血瓶中有四个培养出对多种抗生素敏感的中间型链球菌。在CT引导下，对L4至L5椎间隙进行了三次芯针活检，随后培养出中间型链球菌。他报告称其最后一次牙科治疗发生在20多年前，牙科全景X光片显示有严重的坏死牙列。拔除了十颗牙齿，坏死牙列被认为是最可能的感染源。出院时，他接受了为期12周的静脉注射头孢曲松治疗，随后口服头孢羟氨苄8周，等待复查影像。
本病例报告表明，对于自发性脊柱感染患者确定感染源很重要。即使近期没有牙科手术，对于出现自发性脊柱感染的免疫功能正常患者，牙列也应被视为可能的感染源。
