An uncommon case of Mycoplasma hominis infection after total disc replacement

Abstract

Purpose Beside mechanical complications, the majority of adverse events after total disc arthroplasty (TDA) are related to the surgical approach. Septic complications are very uncommon and only one previous case has been published. The objective of this article is to describe the clinical circumstances, treatment, and outcomes of septic complication after TDA at L4-L5, involving an uncommon pathogen (Mycoplasma hominis). Methods A 38-year-old woman underwent a MobiDisc Ò TDA at L4-L5 level for discogenic pain. One month postoperatively, she complained of acute low back and abdominal pain associated with fever (39°C). C-reactive protein level was elevated (197 mg/L; normal \5 mg/L) and the white blood cell count was normal (7 9 10 9 /L; normal 4-10 9 10 9 /L). A computerized tomography (CT) showed a left psoas-based retroperitoneal abscess. Treatment consisted of open debridement, drainage and empirical antibiotic therapy. Intraoperative cultures yielded M. hominis after 7 days incubation. Antibiotic therapy was adapted and discontinued after 2 months. The patient had failed to mention earlier that she had been suffering from abnormal vaginal discharge for some time and was using an intrauterine contraceptive device. Results At 1.5-year follow-up, review confirmed healing of the infection with biological normalization without residual collection, radiolucent lines or osteolysis around the prosthesis at radiographs, CT and MRI.Conclusions Mycoplasma hominis can be involved as an extragenital pathogen in musculoskeletal infections. Because its culture and identification are difficult, special media and real-time PCR are required in case of postoperative deep wound infection after anterior lumbar spine surgery, especially in the case of previous genitourinary infections, to decrease the delay in diagnosis and treatment.

Presentation and management of infection in total disc replacement: A review

“…FU Xia 2019 [39] C6–7 (M6–C) Dysphagia and neck mass 3 years Normal CT and MRI: prevertebral collection near device Device removed, conversion to fusion with cage/allograft Antibiotics: (post-op) IV benzylpenicillin and moxifloxacin for 6 weeks with ongoing amoxicillin Aspirate culture negative Intraoperative cultures positive for C. acnes sensitive to penicillin and moxifloxacin Solid bony union, no recurrence of the collection at 29 mos. FU Lumbar Flouzat-Lachaniette 2013 [40] L4–L5 (MobiDisc) Low back and abdominal pain, fever, nausea 1 month Elevated CRP and normal WBC CT: abscess Device left in place due to difficulty accessing it Antibiotics (post-op) IV cephotaxime and fosfomycin, switched to oral doxycycline after organism identified Fluid aspiration and abscess cultures positive for mycoplasma hominis Infection parameter normalized at 2 mos. FU; well-functioning device, no osteolysis or residual collection at 1.5 years FU Hoffmann 2020 [41] L4–L5 (M6–C) Cutaneous fistulas in abdomen, lumbar tenderness, significant pain Case 1: 9 mos.…”

Mycoplasma hominisperitonitis after oocyte donation

“…Since then, a variety of M. hominis genital infections have been reported 11. Besides, it has been implicated in prosthetic and periprosthetic osteoarticular infection,13–15 retroperitoneal and pelvic abscesses,9 16–18 endocarditis,19 septic arthritis,20 postsurgical meningitis,21 brain abscess22 and ventriculitis 23…”

Postoperative Mycoplasma hominis infections after neurosurgical intervention

“…The first was a 38-year-old woman who presented 1 month after L4/5 disc replacement with fever to 39°C, C-reactive protein of 197, and a normal white blood cell (WBC) count of 7000/dl. 8 A left psoas-based retroperitoneal abscess was discovered. Cultures grew M. hominis after 7 days.…”