Voisin L, Vittecoq O, Mejjad O, Krzanowska C, Defives T, Cambon-Michot C, Le Loët X
Department of Rheumatology, Rouen University Hospital, France.
Spine (Phila Pa 1976). 1998 Feb 15;23(4):487-90. doi: 10.1097/00007632-199802150-00016.
Report of a rare case of spinal actinomycosis in a young immunocompetent woman.
To show the difficulties in diagnosing spinal actinomycosis.
Spinal actinomycosis is rare and usually occurs as a result of a contiguous (abdominal, pelvic, or thoracic) spread of the infection. This localization represents less than 5% of the infectious sites and was mainly, before the penicillin era, a postmortem discovery.
A case is reported of a 34-year-old Algerian woman who had fever, persistent cough, right-side thoracic pain, and progressive severe back pain. Radiographs, computed tomographic scan, and magnetic resonance imaging demonstrated lytic areas on the vertebral bodies of T11 and T12 and a paravertebral mass, without disk involvement. A surgical biopsy of T12 and the paravertebral abscess was performed.
Presence of characteristic sulfur granules and gram-positive filamentous bacteria in surgical biopsy tissues and isolation of Actinobacillus actinomycetemcomitans in cultures led to the diagnosis of vertebral actinomycosis. The patient was virtually free of pain and fever after a 3-month regimen of ofloxacin and rifampicin (Rifadine, Marion-Merell, France) and was without recurrence after 18 months of follow-up.
Actinomycosis of the spine, caused by the spread of a paraspinal abscess, is extremely rare. The previously poor prognosis has been transformed by antibiotics.
一名免疫功能正常的年轻女性脊柱放线菌病罕见病例报告。
展示脊柱放线菌病诊断中的困难。
脊柱放线菌病罕见，通常是感染的连续性（腹部、盆腔或胸部）扩散所致。这种定位在感染部位中占比不到5%，在青霉素时代之前，主要是尸检时发现。
报告一例34岁阿尔及利亚女性病例，她有发热、持续性咳嗽、右侧胸痛和进行性严重背痛。X线片、计算机断层扫描和磁共振成像显示第11和12胸椎椎体有溶骨性区域及椎旁肿块，未累及椎间盘。对第12胸椎和椎旁脓肿进行了手术活检。
手术活检组织中存在特征性硫磺颗粒和革兰氏阳性丝状菌，培养物中分离出伴放线放线杆菌，从而诊断为椎体放线菌病。患者在接受3个月的氧氟沙星和利福平（法国美罗培南公司的利福定）治疗后基本无疼痛和发热症状，随访18个月无复发。
由椎旁脓肿扩散引起的脊柱放线菌病极为罕见。抗生素已改变了以往较差的预后。
