Vertebral osteomyelitis caused by Mycobacteroides abscessus subsp. abscessus resulting in spinal cord injury due to vertebral body fractures |
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| Institution: | 1. Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan;2. Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;3. Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;4. Section of Clinical Laboratory, Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan;5. Division of Clinical Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan;6. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;7. Translational Research Center, Hiroshima University, Hiroshima, Japan;1. Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan;2. Department of Urology, JA Mie Komono Kosei Hospital, Fukumura 75, Komono-cho, Mie-gun, Mie, 510-1234, Japan;3. Infection Control Team, JA Mie Komono Kosei Hospital, Fukumura 75, Komono-cho, Mie-gun, Mie, 510-1234, Japan;1. Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China;2. Department of Blood Transfusion, Affiliated Hospital of Zunyi Medical University, Zunyi, China;3. School of Laboratory Medicine, Zunyi Medical University, Zunyi, China;1. Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan;2. Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan;3. Department of Digestive Tract Internal Medicine, Tokyo General Hospital, Tokyo, Japan;4. Department of Clinical Laboratory, Tokyo General Hospital, Tokyo, Japan;1. Research Center for Infection Control, ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan;2. External Innovation, Drug Research Division, Sumitomo Dainippon Pharma Co., Ltd, Japan;1. Department of Internal Medicine, Rambam Healthcare Campus, Haifa, Israel;2. Hematology Department and Bone Marrow Transplantation Unit, Rambam Healthcare Campus, Haifa, Israel;3. Infectious Disease Institute, Rambam Healthcare Campus, Haifa, Israel |
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| Abstract: | Nontuberculous mycobacteria (NTM) rarely cause vertebral osteomyelitis; however, the clinical characteristics of vertebral osteomyelitis caused by NTM are poorly understood due to its rarity. A 74-year-old man with lung cancer was treated with prednisolone for immune checkpoint inhibitor-associated immune-related adverse events. He had been experiencing mild back pain without febrile episodes for five months, and was admitted to the hospital for worsening back pain and progressive paraplegia. Magnetic resonance imaging showed spinal cord compression at T4-5 due to fractures of the T5 and T7 vertebral bodies. The culture of a sample of pus from the T7 vertebral body obtained at the time of spinal fusion surgery yielded the Mycobacteroides abscessus (M. abscessus) complex. The patient was diagnosed with vertebral osteomyelitis caused by M. abscessus complex and treated with clarithromycin, amikacin, and imipenem; clarithromycin was later replaced by sitafloxacin because of inducible macrolide resistance. However, his neurologic deficits were irreversible, and he died due to a deteriorating general condition. The strain was identified up to subspecies level as M. abscessus subsp. abscessus by hsp65 and rpoB sequencing and nucleic acid chromatography. Although vertebral osteomyelitis due to NTM is rare, delayed diagnosis can lead to serious complications or poor outcomes. A prolonged clinical course, less frequent fever, vertebral destruction or spinal deformity, neurological deficits, or immunosuppressed conditions might be suggestive of NTM vertebral osteomyelitis. |
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| Keywords: | Nontuberculous mycobacteria Vertebral osteomyelitis Nucleic acid chromatography Spinal cord injury |
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