J Korean Neurosurg Soc.  2011 Nov;50(5):460-463. 10.3340/jkns.2011.50.5.460.

An Unusual Case of Post-Operative Spondylitis Caused by Mycobacterium Intracellulare in an Immunosuppressed Patient

• Kim SH
• Son DW
• Lee SW
• Song GS

• KMID: 2190447
• DOI: http://doi.org/10.3340/jkns.2011.50.5.460

Abstract

There are few reported cases of post-operative spondylitis caused by Mycobacterium intracellulare. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, Mycobacterium intracellulare was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.

Keyword

Post-operative spondylitis; Mycobacterium intracellulare

MeSH Terms

Aged
Biopsy
Blood Sedimentation
C-Reactive Protein
Epidural Abscess
Female
Fever
Fractures, Compression
Hematoma
Humans
Low Back Pain
Magnetic Resonance Spectroscopy
Multiple Organ Failure
Mycobacterium
Mycobacterium avium Complex
Neurologic Manifestations
Osteomyelitis
Paraparesis
Polymerase Chain Reaction
Spinal Cord
Spondylitis
C-Reactive Protein