title: Delayed spinal infection after laminectomy in a patient with rheumatoid arthritis interruptedly exposed to anti-tumor necrosis factor alpha agents.
abstract: We report a case of spondylodiscitis caused by Staphylococcus aureus 8 months after laminectomy of the lumbar spine, occurring in a rheumatoid arthritis (RA) patient interruptedly treated with anti-tumor necrosis alpha (TNFalpha) agents. The patient had suffered from seropositive RA for 2 years. An intravenous infusion (200 mg) of infliximab, a chimeric antibody against human TNFalpha, was introduced; however, due to Pneumocystis jiroveci pneumonia, this therapy was withdrawn. Four months later, the patient underwent an L3-L4 and L4-L5 laminectomy for spinal stenosis. Two months after surgery, we started treatment with 25 mg of etanercept, a soluble humanized TNF receptor dimer, subcutaneously twice a week. At that time, wound healing was satisfactory and no evidence of infection was obtained. Eight months after surgery, septic spondylodiscitis of the lumbar spine occurred. To the best of our knowledge, this is the first case in the literature to show a delayed type of postoperative infection as a complication of non-instrumented orthopedic surgical procedures. Despite interruption of anti-TNFalpha therapy before surgery, patients may remain at risk of developing postoperative infections.
authors.affiliation: Clinical Research Center for Rheumatic Disease and Department of Rheumatology, Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, 861-1196, Japan, moris@saisyunsou1.hosp.go.jp.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Mori
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tomita
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Horikawa
authors.forename: Isamu
authors.initials: I
authors.lastname: Cho
authors.forename: Mineharu
authors.initials: M
authors.lastname: Sugimoto
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D015299:Discitis / Q000209:etiology / Q000382:microbiology*; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D000069285:Infliximab; D007796:Laminectomy / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000601:surgery; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D013130:Spinal Stenosis / Q000209:etiology / Q000601:surgery; D013203:Staphylococcal Infections / Q000382:microbiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept