title: An unusual case of post-operative spondylitis caused by mycobacterium intracellulare in an immunosuppressed patient.
abstract: There are few reported cases of post-operative spondylitis caused by Mycobacterium intracellulare. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, Mycobacterium intracellulare was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.
authors.affiliation: Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan Hospital, Yangsan, Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Dong Wuk
authors.initials: DW
authors.lastname: Son
authors.forename: Sang Weon
authors.initials: SW
authors.lastname: Lee
authors.forename: Geun Sung
authors.initials: GS
authors.lastname: Song