Dyal Natasha Priya, Orenstein Robert, Nagarakanti Sandhya Rani
Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
J Clin Med. 2024 Nov 28;13(23):7241. doi: 10.3390/jcm13237241.
: Culture-negative vertebral osteomyelitis presents a significant diagnostic challenge. () is a typically benign commensal organism of the upper respiratory tract that rarely causes invasive infections, warranting cautious interpretation if isolated in a single positive culture. This case study details a 62-year-old male diagnosed with vertebral osteomyelitis caused by , examining diagnostic challenges, treatment, and outcomes. : We conducted a comprehensive search on MEDLINE using the keywords "", "osteomyelitis", and "diskitis". An additional search excluding and was also performed, revealing a total of four cases of osteomyelitis in the literature. : A 62-year-old male with a history of hypertension, type 2 diabetes, atrial fibrillation, and previous L5-S1 spinal fusion presented with fever and back pain in May 2023. Initial imaging revealed T8-T9 vertebral osteomyelitis. Despite a six-week course of IV daptomycin, his symptoms worsened, prompting further evaluation. A CT-guided biopsy with comprehensive testing, including histopathology and microbial cultures, initially identified . Due to its rarity, additional biopsies were conducted, confirming the infection. IV ceftriaxone was initiated, leading to significant pain improvement, and a subsequent MRI showed near resolution. The patient transitioned to oral cefuroxime, with follow-up confirming complete infection resolution by December 2023. : This case underscores the importance of a structured diagnostic approach in culture-negative vertebral osteomyelitis to differentiate between commensal contamination and true infection. Repeated positive cultures of from a sterile site confirmed its role as the causative agent. Early identification and targeted antibiotic therapy are critical to improving outcomes in rare cases of vertebral osteomyelitis.
培养阴性的脊椎骨髓炎带来了重大的诊断挑战。（某菌）是上呼吸道一种典型的良性共生菌，很少引起侵袭性感染，若在单次阳性培养中分离出该菌，需要谨慎解读。本病例研究详细介绍了一名62岁男性被诊断为由（某菌）引起的脊椎骨髓炎，探讨了诊断挑战、治疗方法及治疗结果。我们使用关键词“（某菌）”“骨髓炎”和“椎间盘炎”在MEDLINE上进行了全面检索。还进行了一次排除（某菌）的额外检索，结果显示文献中共有4例（某菌）骨髓炎病例。一名有高血压、2型糖尿病、心房颤动病史且既往有L5 - S1脊柱融合术的62岁男性于2023年5月出现发热和背痛。初始影像学检查显示T8 - T9椎体骨髓炎。尽管接受了为期六周的静脉注射达托霉素治疗，但其症状仍恶化，促使进一步评估。通过CT引导下活检并进行包括组织病理学和微生物培养在内的全面检测，最初鉴定出（某菌）。由于其罕见性，又进行了额外的活检，确诊了感染。开始静脉注射头孢曲松，疼痛明显改善，随后的MRI显示病情接近缓解。患者转为口服头孢呋辛，随访证实到2023年12月感染已完全消除。本病例强调了在培养阴性的脊椎骨髓炎中采用结构化诊断方法以区分共生菌污染和真正感染的重要性。从无菌部位多次培养出（某菌）阳性证实了其作为病原体的作用。在罕见的（某菌）脊椎骨髓炎病例中，早期识别和针对性抗生素治疗对于改善治疗结果至关重要。
