A case of mycobacterial osteomyelitis with difficulty in treatment

Abstract

A 66-year-old man complained of back pain and night fever for 2 weeks. He had a medical history of bladder carcinoma treated with intravesical BCG therapy. Pyogenic spondylitis was suspected when he visited our hospital. Needle biopsy of the vertebral body of L4 was performed, and cefazolin and clindamycin were administered intravenously. After 2 weeks, Mycobacterium tuberculosis was proven by culture, and the antibiotics were changed to antituberculous drugs consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, spondylitis progressed. Debridement was planned. The curettage of the infected vertebral body of L4, the transplantation of iliac bone autograft, and percutaneous pedicle screw fixation were performed. Antituberculous drugs were continuously administered postoperatively, but magnetic resonance imaging showed no improvement. The specimen obtained from the surgery was susceptible to those drugs. Further debridement was required. During the second surgery, the curettage of the epidural abscess by posterior approach was performed. Subsequently, after 1 week, the curettage of the iliac bone graft, the vertebral body of L5, paravertebral abscess, transplantation of fibula strut and pedicle flap of the greater omentum into the dead space by transabdominal approach were performed. The antibiotics were administered continuously for 18 months, and the spondylitis eventually healed.