title: An uncommon case of Mycoplasma hominis infection after total disc replacement.
abstract: OBJECTIVE
  Beside mechanical complications, the majority of adverse events after total disc arthroplasty (TDA) are related to the surgical approach. Septic complications are very uncommon and only one previous case has been published. The objective of this article is to describe the clinical circumstances, treatment, and outcomes of septic complication after TDA at L4-L5, involving an uncommon pathogen (Mycoplasma hominis).
  
  
  METHODS
  A 38-year-old woman underwent a MobiDisc(®) TDA at L4-L5 level for discogenic pain. One month postoperatively, she complained of acute low back and abdominal pain associated with fever (39 °C). C-reactive protein level was elevated (197 mg/L; normal <5 mg/L) and the white blood cell count was normal (7 × 10(9)/L; normal 4-10 × 10(9)/L). A computerized tomography (CT) showed a left psoas-based retroperitoneal abscess. Treatment consisted of open debridement, drainage and empirical antibiotic therapy. Intraoperative cultures yielded M. hominis after 7 days incubation. Antibiotic therapy was adapted and discontinued after 2 months. The patient had failed to mention earlier that she had been suffering from abnormal vaginal discharge for some time and was using an intrauterine contraceptive device.
  
  
  RESULTS
  At 1.5-year follow-up, review confirmed healing of the infection with biological normalization without residual collection, radiolucent lines or osteolysis around the prosthesis at radiographs, CT and MRI.
  
  
  CONCLUSIONS
  Mycoplasma hominis can be involved as an extragenital pathogen in musculoskeletal infections. Because its culture and identification are difficult, special media and real-time PCR are required in case of postoperative deep wound infection after anterior lumbar spine surgery, especially in the case of previous genitourinary infections, to decrease the delay in diagnosis and treatment.
authors.affiliation: Hôpital Henri Mondor, AP-HP - UPEC, Institut du Rachis - Service de Chirurgie Orthopédique et Traumatologique, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil Cedex, France. charles-henri.flouzat-lachaniette@hmn.aphp.fr
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Flouzat-Lachaniette
authors.forename: Julie
authors.initials: J
authors.lastname: Guidon
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allain
authors.forename: Alexandre
authors.initials: A
authors.lastname: Poignard
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D009175:Mycoplasma Infections / Q000209:etiology* / Q000628:therapy; D019535:Mycoplasma hominis; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D016659:Psoas Abscess / Q000209:etiology* / Q000628:therapy; D060888:Real-Time Polymerase Chain Reaction; D059145:Total Disc Replacement / Q000009:adverse effects*