title: Diagnosis and treatment of Fusobacterium nucleatum discitis and vertebral osteomyelitis: case report and review of the literature.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  We present a case of vertebral osteomyelitis and discitis caused by Fusobacterium nucleatum in a 42-year-old female.
  
  
  BACKGROUND
  Infection of the vertebral bodies or disc space with this organism is rare. A review of the English literature disclosed 13 cases of vertebral osteomyelitis caused by Fusobacterium spp. Because of the negative impact of this condition on the affected patients' activities of daily living, it is important to understand the clinical character and effective management of the disease to improve quality of life. Fusobacterium is an anaerobic and gram-negative microbe that is part of the normal flora of the mouth, gastrointestinal tract, and female genital tract. It is the main cause of Lemierre syndrome and has also been seen in septicemia.
  
  
  METHODS
  The patient presented to our institution with a 3-month history of severe lower back pain. Her back pain was diagnosed as vertebral osteomyelitis. Magnetic resonance images of the lumbar spine revealed decreased T2 signal in the L3 and L4 vertebral bodies. Computed tomographic scan demonstrated asymmetrical disc height loss between vertebral bodies L3 and L4 and associated periosteal reaction.
  
  
  RESULTS
  Computed tomography-guided biopsy of vertebral bodies L3 and L4 revealed microorganism Fusobacterium nucleatum with the following in vitro susceptibilities: clindamycin ≤0.5 S, metronidazole ≤0.5 S, penicillin ≤0.5 S, ertapenem ≤4 S. Parenteral ertapenem, at a dose of 1 g every 24 hours for 8 weeks in combination with oral amoxicillin and clavulanate as oral suppression was used as medical management. At 1-month follow-up after medical treatment, the patient's inflammatory markers returned to normal values, and the infection resolved with L3-L4 autofusion.
  
  
  CONCLUSIONS
  We report a rare case of Fusobacterium vertebral osteomyelitis. This condition is associated with several comorbid and concomitant conditions including gastrointestinal complications. Effective treatment includes thoracolumbar orthosis bracing and intravenous antibiotic therapy.
authors.affiliation: Division of Infectious Diseases, Department of Orthopedic Surgery, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. ramos.amanda@mayo.edu
authors.forename: Amanda
authors.initials: A
authors.lastname: Ramos
authors.forename: Elie
authors.initials: E
authors.lastname: Berbari
authors.forename: Paul
authors.initials: P
authors.lastname: Huddleston
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001915:Braces; D019818:Clavulanic Acid / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015299:Discitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004359:Drug Therapy, Combination; D000077727:Ertapenem; D005260:Female; D005674:Fusobacterium Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016967:Fusobacterium nucleatum / Q000302:isolation & purification; D006801:Humans; D007403:Intervertebral Disc / Q000382:microbiology / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D019818:Clavulanic Acid; D000658:Amoxicillin; D000077727:Ertapenem