Discitis-osteomyelitis (Eikenella corrodens)

Case contributed by A.Prof Frank Gaillard

Presentation

One week history of back pain with new constipation. Normal neurology. CRP 70.

Patient Data

Age: 50 years
Modality: CT

Increased sclerosis within the inferior aspect of the L2 vertebral body with cortical destruction of the right anteroinferior endplate. Small volume hyperattenuation posteriorly to the L2 vertebral body which appears subligamentous resulting in indentation of the anterior thecal sac. No high- grade central canal stenosis. Paraspinous soft tissue thickening with associated retroperitoneal fat stranding. 

Modality: MRI

There is diffuse marrow signal abnormality involving the L2 vertebral body with T1 hypointensity, increased fluid signal and vertebral body enhancement. Signal abnormality extends beyond the anteroinferior corner of the endplate with linear T2 hyperintensity within the superior aspect of the L2/3 intervertebral disc and involves the anterosuperior corner of the vertebra below. There is prominent pre-vertebral enhancing soft tissue stranding extending into the medial psoas muscles bilaterally. The posterior cortex of the vertebral body is intact and there is no abnormal enhancing soft tissue within the anterior epidural space. There is subtle T2 hyperintensity and enhancement within the left L2 and to a greater extent the left L3 pedicles. 

Conclusion: Features are almost certainly those of infection. The apparent subligamentous spread with sparing of the disc raises the possibility of tuberculosis. 

Case Discussion

The patient went on to have surgery. 

Histology

MICROSCOPIC DESCRIPTION: The sections contain partly calcified lamellar and woven bony trabeculae. Some of these are necrotic with loss of nuclear staining. There are abundant neutrophils in the medullary spaces and in the intervertebral disc. Scattered multinucleated osteoclast-like giant cells are noted. There are no necrotising granulomas. No tumour is identified. The Gram stain shows no bacteria. The Grocott stain shows no fungi. The Ziehl-Neelsen stain shows no acid fast bacilli.

Microbiology 

MICROSCOPY GRAM STAIN

  • Gram stain: Leucocytes ++ No organisms seen.
  • Auramine-Rhodamine stain: No Acid Fast Bacilli Detected A negative acid-fast smear result does not exclude the presence of Mycobacterium species. 

CULTURE

  • Eikenella corrodens

rRNA PCR

  • Bacterial Identification 16S rRNA PCR : DETECTED
  • 16S Sequence Result : Eikenella corrodens (99.9%)

MYCOBACTERIUM CULTURE (MGIT): 56 days = Negative

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Case Information

rID: 46558
Case created: 8th Jul 2016
Last edited: 10th Apr 2017
System: Spine
Inclusion in quiz mode: Included

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