Salmonella vertebral osteomyelitis

Abstract

A 15-year-old (young) woman was admitted to our hospital with a 3 months history of increasingly lower back pain, accompanied by a low grade fever. She complained of back pain exacerbated by movement. There was tenderness on palpation along the lumbar spine posteriorly, associated with paravertebral muscle spasms. There were no neurological finding. Her blood cell (WBC) count was 6,970μl, with 69%neutrophils, and her erythrocyte sedimentation rate was 120 mm/h. No clinically evident systemic or gastrointestinal illness preceded the onset of symptoms. Blood cultures taken at the time of admission remained negative. Bacteriologic examination of feces and urine cultures were negative. Radiographs of the lumbar spine demonstrated narrowing of L3/4 disc space, and irregularity of vertebral end plates of L3/4. Computerized tomography (CT) scan revealed a paravertebral abscess, and magnetic resonance imaging (MRI) showed a change in signal intensity on both T1-and T2-weighted images. Needle biopsy of disc space between the third and fourth lumbar vertebrae and of the fourth lumbar vertebral body was performed under local anesthesia. Culture of L3/4 disc material grew Salmonella oranienburg, but culture material drawn from the fourth lumbar vertebral body grew nothing. The patient received Fosfomycin Sodium (2 g/24 h) for three days, Aztreonam (2 g/24 h) for two weeks, Amikacin sulfate (100 mg/24 h) for five days and Sulfamethoxazole (2 tablets/24 h) for two weeks. She was placed on complete bed rest, and lumbosacral corset was applied. She was reevaluated 4 months after the onset of symptoms. She was well pain-free. She had normal movement of the lumbar spine. Radiographs confirmed spontaneous interbody fusion of the involved adjacent vertebral bodies. Laboratory-test results (WBC count, sedimentation rate, and C-reactive protein), were normal. Salmonellosis rarely causes osteomyelitis in previously healthy young adults. This 15-year-old female was found to have vertebral osteomyelitis due to Salmonella oranienburg. Standard treatment with aztreonam and sulfamethoxazole cured the infection. She recovered after a course of moxaiactam therapy.