Multifocal spinal and extra‐spinal Mycobacterium chelonae osteomyelitis in a renal transplant recipient

• Published in: Transplant infectious disease Vol. 9; no. 1; pp. 62 - 65
• Main Authors: Korres, D.S., Papagelopoulos, P.J., Zahos, K.A., Kolia, M.D., Poulakou, G.G., Falagas, M.E.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-03-2007
• Subjects: Anti-Infective Agents - therapeutic use; Cervical Vertebrae - pathology; Ciprofloxacin - therapeutic use; Clarithromycin - therapeutic use; corticosteroid therapy; Discitis - etiology; Graft Rejection - prevention & control; Humans; immunosuppression; Immunosuppressive Agents - administration & dosage; Kidney Transplantation - adverse effects; Kyphosis - etiology; magnetic resonance imaging; Male; Middle Aged; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous - etiology; organ transplantation; osteomyelitis; Osteomyelitis - etiology; Postoperative Complications; Risk Factors; spinal infections; spondylodiscitis; Tuberculosis, Spinal - etiology
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/j.1399-3062.2006.00178.x

: Only localized cases of Mycobacterium chelonae osteomyelitis have been reported. In this article, a 55‐year‐old immunosuppressed man with M. chelonae osteomyelitis and multiple spinal and extra‐spinal involvement is presented. The patient had nodulo‐pustular skin lesions, spondylodiscitis at multiple levels, and osteolytic lesions at extra‐spinal locations. Biopsy and cultures of the osseous lesions showed M. chelonae osteomyelitis. The patient started antimycobacterial chemotherapy with ciprofloxacin and clarithromycin. Progressive cervical kyphosis associated with anterior wedged deformity of the C5 vertebra and posterior C5–C6 spondylolisthesis resulted in compression of the spinal cord and neurological impairment. The patient underwent anterior decompression and C4–C6 arthrodesis using a titanium mesh cage and cervical plate. About 15 months after the initiation of chemotherapy and 5 months after surgery, the patient was pain free, with significant improvement of his neurological function. In the presence of immunosuppression, the physician should be alert for unusual or opportunistic pathogens of osteomyelitis. Long‐term antimicrobial chemotherapy and surgical intervention is the cornerstone of successful treatment of multifocal bone M. chelonae infection.