title: Vertebral osteomyelitis associated with Granulicatella adiacens.
abstract: Granulicatella adiacens is a nutritionally variant streptococci. Only 3 cases of vertebral osteomyelitis due to these microorganisms have been reported. We experienced a 73-year-old male who consulted us due to fever and back pain of about 1-month duration. On examination, a presystolic murmur was heard in the apical region. Echocardiography showed prolapse of the mitral valve, but no vegetation was observed. MRI revealed osteomyelitis of lumbar vertebrae. As G. adiacens was detected in blood culture, it was determined as the cause of vertebral osteomyelitis, and combination antibiotics therapy was started. The condition improved, the patient underwent valvoplasty, and no trace of infective endocarditis was noted in the resected valve. All the previous cases had infection caused by G. adiacens and complicated with infective endocarditis. This is the first case without infective endocarditis. Vertebral osteomyelitis due to NVS is very rare. Since nutritionally variant streptococci do not grow in common culture media, and since the sensitivity of isolation by standard conventional biochemical methods is low, the condition may be misdiagnosed as blood-culture-negative vertebral osteomyelitis. Therefore, the possibility of nutritionally variant streptococci infection should be considered if a patient with vertebral osteomyelitis shows a positive Gram stain but negative blood cultures.
authors.affiliation: Department of General Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan. f.ryuki@is.icc.u-tokai.ac.jp
authors.forename: Ryuki
authors.initials: R
authors.lastname: Fukuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Oki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ueda
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Yanagi
authors.forename: Masamichi
authors.initials: M
authors.lastname: Komatsu
authors.forename: Masahito
authors.initials: M
authors.lastname: Itoh
authors.forename: Akiko
authors.initials: A
authors.lastname: Oka
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishina
authors.forename: Hideki
authors.initials: H
authors.lastname: Ozawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D056568:Carnobacteriaceae / Q000472:pathogenicity*; D004696:Endocarditis; D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology*; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents