A Case Report: Mycobacterium fortuitum Spondylodiscitis

Abstract

Spondylodiscitis refers to infection of both the intervertebral disc and vertebrae. It may develop primarily or as a healthcareassociated infection following spinal surgeries [1] .Tuberculosis (TB) is still endemic in Turkey, and can cause extrapulmonary involvement in various systems. One of the common sites of extrapulmonary TB is bone, with 10% of cases having vertebral involvement. Nontuberculous mycobacterial (NTM) infections are usually sporadic. Of the NTM, Mycobacterium fortuitum, is rarely an infectious agent, but can cause infections after trauma or surgery, especially infections associated with orthopedic implants [2] . Herein, we present a case of spondylodiscitis due to M. fortuitum.A 44-year-old female patient with no known chronic disease underwent surgery at another center in 2000 and 2007 due to a herniated disc at L4-L5. Approximately one month after the second surgery, she presented to the neurosurgery clinic of our hospital due to increased pain in her lower back and legs. Examination and imaging revealed lumbar stenosis at L4-L5, and the patient underwent L4-L5 laminectomy and L4-L5-S1 posterior fixation. Five months after discharge, the patient presented to a private medical center for persistent leg and lower back pain and underwent a fourth operation. Some of the screws at L4 appeared infected and were removed during the procedure. Afterwards, she was given an antibiotic for over three weeks, but she did not know the name of it. The patient's complaints of pain in the legs and lower back persisted during the first postoperative month. Lumbar magnetic resonance imaging (MRI) showed an abscess formation with peripheral enhancement, over 5 cm in diameter, extending to the L5-S1 pedicular screws and under the skin posterior to L4-L5. The patient was readmitted to the neurosurgery clinic of our hospital and underwent abscess drainage and debridement. Rose Bengal test performed at this time was negative. A specimen taken from the abscess was analyzed with bacterial culture, mycological culture, TB culture, acid-fast bacillus (AFB) staining, and pathological examination. Bacterial and mycological cultures did not yield any pathogen and AFB staining was negative. Inflammatory granulation tissue was observed in pathological examination. Consultation was requested due to the patient's negative cultures; the patient was started on empirical ceftriaxone and teicoplanin therapy and transferred to Infectious Diseases Clinic postoperatively. After nearly one month of antibiotherapy with ceftriaxone and teicoplanin and follow-up in our clinic, recurrent abscess was observed on control lumbar MRI. The patient was transferred