title: Burkholderia pickettii spondylitis.
abstract: METHODS
  Case report describing Burkholderia pickettii spondylitis in a healthy adult.
  
  
  OBJECTIVE
  To describe this very rare form of spondylitis and to discuss some of the difficulties in the diagnosis of B. pickettii spondylitis.
  
  
  METHODS
  Department of Orthopaedic Surgery, Nayoro City General Hospital, Japan.
  
  
  METHODS
  A 48-year-old woman presented with a complaint of severe back pain radiating from the right side of her chest. Plain radiographs of the spine showed osteolytic destruction of the right side of the T10 vertebral body at T10 level, with an involvement of the pedicle. Magnetic resonance image of the spine showed a low signal intensity from the T10 vertebral body on a Tl-weighted image and an increased signal intensity on T2-weighted sequence image. These lesions were enhanced when a contrast medium was used. The patient underwent open biopsy and specimens were collected through the right pedicle.
  
  
  RESULTS
  Diagnosis was established on the basis of direct identification of the microorganism. Histological findings were consistent with examination of B. pickettii spondylitis. Chemotherapy (intravenous cefepime and per os minocycline) resulted in complete cure.
  
  
  CONCLUSIONS
  B. pickettii is widely distributed in aqueous sources in nature and has not previously been considered to be an aggressive pathogen towards humans. This case report will help to improve our understanding of the ecology and virulent pathogenicity of this organism. A biopsy is an essential and reliable method for the early etiologic diagnosis, which will lead to prevent the development of more severe complications such as spinal cord compression.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sudo
authors.forename: Y
authors.initials: Y
authors.lastname: Hisada
authors.forename: M
authors.initials: M
authors.lastname: Ito
authors.forename: H
authors.initials: H
authors.lastname: Kotaki
authors.forename: A
authors.initials: A
authors.lastname: Minami
mesh_terms: D019121:Burkholderia Infections / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D013116:Spinal Cord / Q000382:microbiology / Q000473:pathology; D013166:Spondylitis / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D013904:Thoracic Vertebrae