Abstract
A 61-year-old man was admitted to our hospital because of a one-month history of severe low back pain and a high-grade fever after acute otitis media caused by Streptococcus pneumoniae, which had been isolated from otorrhea fluid from his right ear. At 54 years of age, he was diagnosed with slowly progressive type 1 diabetes mellitus based on laboratory data showing GAD antibody-positivity and low insulin secretion. He was treated with intensive insulin therapy, and his HbA1c levels had been maintained below 7%. CT showed osteolytic change in his spine at the L2 level along and a left psoas abscess. MRI revealed that vertebral bodies L2-L3 were diffuse low signal intensity on the T1-weighted image, and diffuse enhancement was observed on a contrast-enhanced Gd-DTPA image. We diagnosed pyogenic vertebral osteomyelitis secondary to acute otitis media caused by Streptococcus pneumoniae. Necrotic tissue was removed, and his lumbar spine was fixed with posterior instrumentation. Streptococcus pneumoniae a common etiologic agent of pneumonia and is also responsible for unusual invasive pneumococcal infections, such as pyogenic osteomyelitis. Diabetes mellitus is one of the factors predisposing to invasive pneumococcal infection and may have contributed to the establishment of the lumbar spine infection in our patient.
