title: Idiopathic vertebral abscess in pregnancy: case report and literature review.
abstract: Pregnant women are prone to complications from many infections. However, overwhelming soft tissue infections are rarely reported in pregnant women without predisposing factors. A 40-year-old multipara presented with complaints of progressively worsening spinal muscle spasm pain. Because her medical history consisted of preterm deliveries, she was receiving injections of 17-alpha-hydroxyprogesterone caproate (17P). An imaging study revealed replacement of the vertebral marrow with a homogeneous substance. A biopsy stained for gram-positive cocci. Blood culture bottles grew STAPHYLOCOCCUS AUREUS. The lesion was re-aspirated, and grew the same isolate. The patient was treated with antibiotics and had resolution of her pain. Mother and infant did well, and she completed a prolonged course of antibiotics. This study presents an unusual case of idiopathic vertebral osteomyelitis and epidural abscess during pregnancy. Potential reasons for failure to display a systemic response to this infection with associated bacteremia include an innate variation in the patient's immune system and modification in immunity from progesterone therapy. The role that 17P played in this case, if any, is unknown.
authors.affiliation: Department of Obstetrics and Gynecology, Brown Medical School/Women & Infants' Hospital of Rhode Island, Providence, Rhode Island, USA.
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Anderson
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Nau
authors.forename: Hyagriv N
authors.initials: HN
authors.lastname: Simhan
mesh_terms: D000077713:17 alpha-Hydroxyprogesterone Caproate; D000038:Abscess / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D006908:Hydroxyprogesterones / Q000008:administration & dosage; D007273:Injections, Intramuscular; D008279:Magnetic Resonance Imaging; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011372:Progestins / Q000008:administration & dosage; D013122:Spinal Diseases / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D006908:Hydroxyprogesterones; D011372:Progestins; D000077713:17 alpha-Hydroxyprogesterone Caproate