Thoracic spondylitis from a mycotic (Streptococcus pneumoniae) aortic aneurysm: a case report.
METHODS
We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described.


BACKGROUND
Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies.


METHODS
The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 x 0.5 g/day, Cefotaxim 3 x 2 g/day, and Flucloxacillin 3 x 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter.


RESULTS
The patient made a good recovery and is free of recurrence 4 years after surgery.


CONCLUSIONS
Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.
Englert
Carsten
C
Department of Trauma and Reconstructive Surgery, University of Regensburg Hospital, Regensburg, Germany. Carsten.Englert@klinik.uni-regensburg.de
Aebert
Hermann
H
Lenhart
Markus
M
Solleder
Albert
A
Nerlich
Michael
M
Neumann
Carsten
C
D000785:Aneurysm, Infected / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002439:Cefotaxime / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015299:Discitis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005436:Floxacillin / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D011008:Pneumococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000188:drug therapy; D011183:Postoperative Complications / Q000209:etiology; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013116:Spinal Cord / Q000098:blood supply; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013166:Spondylitis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D013904:Thoracic Vertebrae / Q000382:microbiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D005436:Floxacillin; D002439:Cefotaxime