Pneumococcal Vertebral Osteomyelitis

• Published in: Clinical infectious diseases Vol. 20; no. 2; pp. 286 - 290
• Main Authors: Kutas, Lisa M., Duggan, Joan M., Kauffman, Carol A.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-02-1995; University of Chicago Press
• Subjects: Aged; Antibiotics; Back pain; Bacterial diseases; Biological and medical sciences; Blood; Bones; Clindamycin - therapeutic use; Clinical Articles; Human bacterial diseases; Humans; Infections; Infectious diseases; Intervertebral Disc - microbiology; Intervertebral Disc - pathology; Lumbosacral Region; Magnetic Resonance Imaging; Male; Medical sciences; Osteomyelitis; Osteomyelitis - drug therapy; Osteomyelitis - microbiology; Osteomyelitis - pathology; Penicillin; Pneumococcal Infections - drug therapy; Pneumococcal Infections - pathology; Radiography; Spinal Diseases - drug therapy; Spinal Diseases - microbiology; Spinal Diseases - pathology; Spine; Staphylococcal infections, streptococcal infections, pneumococcal infections; Vancomycin - therapeutic use; Human; Lumbar spine; Diseases of the osteoarticular system; Vertebra; Bone disease; Streptococcus pneumoniae; Infection; Case study; Streptococcaceae; Osteitis; Streptococcal infection; Bacteriosis; Bacteria; Micrococcales
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/20.2.286

Vertebral osteomyelitis is an unusual complication of pneumococcal infection. This report describes a patient who presented with back pain and lower extremity weakness after bacteremic pneumococcal pneumonia. Magnetic resonance imaging showed destruction of the L-4-L-5 vertebral bodies and thecal sac compression, and Streptococcus pneumoniae was isolated from an aspirate of the disk space. We found only 10 other cases of pneumococcal vertebral osteomyelitis in a review of the literature. In these 11 cases the presentations were usually subacute, and the onset of back pain was insidious. Elevated erythrocyte sedimentation rates were commonly noted. Computed tomography and magnetic resonance imaging were most helpful in delineating the extent of involvement in patients seen in the last decade. Successful treatment included surgery alone in 2 cases that occurred before the antibiotic era, surgery plus 6 weeks of antibiotic therapy in 1, and antibiotics alone for 4 weeks to 7 months in 5. Two patients seen in the preantibiotic era died.