Mycobacterium abscessus ssp. abscessus infection progressing to empyema from vertebral osteomyelitis in an immunocompetent patient without pulmonary disease: a case report

Abstract

Background Pleural involvement by non-tuberculous mycobacteria (NTM) in patients without distinct pulmonary disease is extremely rare. Vertebral osteomyelitis (VO) with or without pulmonary disease is also a rare clinical presentation of NTM infection, and pleural spread of NTM from VO has not been reported. Case presentation A 63-year-old woman was admitted to our hospital with back pain persisting for 4 months and a 2-day history of fever and right chest pain. The patient was initially treated as right-sided empyema due to general bacteria. However, after removal of the chest tube, a previously overlooked paravertebral lesion was observed on CT. MRI confirmed VO at T7/8. Mycobacterium abscessus ssp. abscessus was detected in both the thoracic cavity and the paravertebral lesion. Both VO and the paravertebral abscess were improved by antimycobacterial treatment. Conclusion VO of the thoracic spine due to non-tuberculous mycobacterial infection should be considered as a cause of pleuritis or empyema without pulmonary disease, especially in patients with back pain.

A unique case of Fusobacterium nucleatum spondylodiscitis communicating with a pleural empyema through a fistula

“…Both direct and hematogenous transmission between a spondylodiscitis and a pleural empyema has been reported previously in a few cases [7][8][9][10][11][12][13], however, never with genus Fusobacterium. Transmission between spondylodiscitis and pleural empyema has only been reported with Mycobacterium tuberculosis, Mycobacterium abscessus spp., Streptococcus milleri, Streptococcus gordonii, and group B Streptococcus [7][8][9][10][11][12], neither of which were suspected in our case.…”

“…in a spondylodiscitis and a pleural empyema connected by a fistula. Additionally, concomitant infection with spondylodiscitis and empyema is a rare sight both by direct and hematogenous transmission [7][8][9][10][11][12][13].…”

“…Mycobacterium tuberculosis and Streptococcus milleri can cause concomitant spondylodiscitis and empyema by direct transmission of the infection [7][8][9]. Streptococcus gordonii, Group B Streptococcus, and Mycobacterium abscessus can cause concomitant disease by hematogenous transmission [10][11][12]. Finally, there is a published case of concomitant spondylodiscitis and pleural empyema spread by direct contact without known pathogen [13].…”

Varying clinical presentations of nontuberculous mycobacterial disease : Similar to but different from tuberculosis

“…An interesting case of M. abscessus ssp. abscessus disease was recently reported, which was initially diagnosed as primary pleurisy, but later turned out to be disease progression from VO (65). The major pathogen of VO, including cases with exudative pleural effusion, is Staphylococcus aureus (66,67), but NTM infection should be considered, especially in patients with a history of pre-disposing trauma.…”

Mycobacterium abscessus mimicking tubercular spondylodiscitis following ozone therapy: A case report and review of literature

“…[2] Mycobacterium abscessus (MA) (species abscessus), a rapidly growing species of NTM, is a well-known pathogen of the lung and skin, but rarely can involve the musculoskeletal system. Here, we reviewed 10 cases of vertebral osteomyelitis attributed to MA, [4] the majority of which occurred in immunocompromised patients (n = 6) and/or were from TB-epidemic/endemic areas. [5] Here, we report on a nonimmunocompromised 43-yearold female who developed L4-L5 spondylodiscitis attributed to MA following a relatively unrecognized form of lumbar disc management consisting of ozone therapy.…”