Secondary Discitis Masquerading as Treatment Failure of Primary Discitis: Case Report and Review of the Literature

Abstract

Background: Vertebral osteomyelitis often presents with localized back pain at the site of infection and elevated inflammatory markers. It can generally be treated conservatively with antibiotics targeted at the causative microorganism, but failure of medical treatment often necessitates surgical debridement. There are no reports in the literature that describe a secondary infection masquerading as treatment failure of the primary infection.Methods: We present a case of a 29-year-old male with a history of intravenous drug abuse who was treated with antibiotics for methicillin-sensitive Staphylococcus aureus T6-7 discitis/osteomyelitis. The patient later returned with worsened back pain and was initially thought to have experienced failure of medical therapy, but instead was found to have a secondary discitis at a different level, with biopsy-proven different microorganism (Enterobacter cloacae).Conclusions: This case illustrates the possibility of secondary discitis masquerading as treatment failure of the primary discitis. Repeat imaging and biopsy of the new lesion avoided a surgical procedure in this patient.

Postoperative lumbar spondylodiscitis

“…The culture from a fine-needle aspiration was positive in 1 patient and negative in 5 (19). -serial lumbar MRI with gadolinium contrast enhancement, is the investigation of choice in lumbar POD, due to its very high sensitivity and specificity, also to evaluate the response to treatment (21). In the early stage of POD, MR imaging can not differentiate between the septic and aseptic forms (6), vertebral end-plate erosion is found in the majority of cases in both forms of discitis.…”

“…440 Arsene Anamaria-Alexandra, Iacob Gabriel, Alexandru Vlad Ciurea -positive MR imaging and elevated CRP should be followed by disc puncture and optimal antibiotic therapy. If the bacteriological culture is negative, it is appropriate to choose antibiotics against S. aureus, the most frequent cause of POD (21). In the absence of signal increase on T2-weighted images and undetectable or low improvement after the introduction of the contrast substance a fungal infection should be considered, also a diffuse vertebral infection with Brucella may be difficult to differentiate with TB (21).…”

“…If the bacteriological culture is negative, it is appropriate to choose antibiotics against S. aureus, the most frequent cause of POD (21). In the absence of signal increase on T2-weighted images and undetectable or low improvement after the introduction of the contrast substance a fungal infection should be considered, also a diffuse vertebral infection with Brucella may be difficult to differentiate with TB (21). In the absence of specific MRI characteristics, insignificant values of ESR and CRP, it suggests a non-infectious aseptic etiology or a malignant tumour, in such case a biopsy is used.…”

A minimally invasive lateral approach with CT navigation for open biopsy and diagnosis of Nocardia nova L4–5 discitis osteomyelitis: illustrative case

“…[1][2][3] Vertebral osteomyelitis, also referred to as "discitis osteomyelitis" or "spondylodiscitis," is caused via hematogenous spread from a distant focus. 4 Staphylococcus aureus is known to be the most common causal pathogen accounting for about half of nontuberculosis cases. 5,6 Magnetic resonance imaging (MRI) is commonly accepted as the radiological modality of choice for diagnosis and characterizing the extent of involvement.…”

“… 1–3 Vertebral osteomyelitis, also referred to as “discitis osteomyelitis” or “spondylodiscitis,” is caused via hematogenous spread from a distant focus. 4 Staphylococcus aureus is known to be the most common causal pathogen accounting for about half of nontuberculosis cases. 5 , 6 …”