Atypical fungal vertebral osteomyelitis in a tsunami survivor of the Great East Japan Earthquake.
METHODS
Case report.


OBJECTIVE
We report a rare case of fungal vertebral osteomyelitis in a tsunami survivor of the Great East Japan Earthquake.


BACKGROUND
Fungal vertebral osteomyelitis due to Scedosporium apiospermum (S. apiospermum) is extremely rare. We describe the case of a 45-year-old male who developed vertebral osteomyelitis by S. apiospermum 1 month after near drowning in the huge tsunami after the Great East Japan Earthquake.


METHODS
The patient was treated with a combination of percutaneous posterolateral endoscopic debridement and antifungal therapy. The case was evaluated with radiography and computed tomography, and his white blood cell count and C-reactive protein level in serum were measured 20 months after initiation of treatment.


RESULTS
The patient had no low back pain and both white blood cell count and C-reactive protein had remained normal. Radiographs and computed tomography of lumbar spine demonstrated sclerotic change of endplates and spur formation bridging the L3 and L4 vertebral bodies.


CONCLUSIONS
We report a rare case of the fungal vertebral osteomyelitis caused by S. apiospermum. If a patient develops severe back pain after a near-drowning episode in dirty water such as a swamp or a river, the clinician should be suspicious of the possibility of fungal spondylitis by S. apiospermum.
From the Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Junya
J
Shimizu
Mitsunori
M
Yoshimoto
Tsuneo
T
Takebayashi
Kazunori
K
Ida
Katsumasa
K
Tanimoto
Toshihiko
T
Yamashita
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D004190:Disasters; D055866:Earthquakes; D006801:Humans; D007564:Japan; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D008172:Lung Diseases, Fungal / Q000150:complications; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy; D015701:Near Drowning / Q000150:complications*; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011859:Radiography; D021681:Scedosporium / Q000302:isolation & purification*; D017741:Survivors; D057192:Tsunamis; D014871:Water Microbiology
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents