title: Polymicrobial vertebral osteomyelitis after oesophageal biopsy: a case report.
abstract: BACKGROUND
  While most cases of polymicrobial vertebral osteomyelitis are secondary to hematogenous seeding, direct inoculation during spinal surgery and contiguous spread from adjacent soft tissue are also potential routes whereby pathogens may infect the spine.
  
  
  METHODS
  A 74 year-old man presented with an exacerbation of back pain after a fall. His past medical history included hepatocellular and oesophageal carcinoma. Three months earlier he had undergone an endoscopic biopsy of the oesophagus for routine follow-up of his oesophagus carcinoma. He also underwent a vertebroplasty due to suspected pathologic fracture. On admission to hospital, magnetic resonance imaging revealed an infiltrative process at the level of the 5th and 6th thoracic vertebrae. Blood cultures were positive for both Streptococcus mitis and Gemella morbillorum. During his course of antibiotic therapy he developed an abscess at the level of 8th thoracic vertebrae and culture of this abscess grew Candida albicans. He was treated with antibiotics and antifungal drugs and recovered fully.
  
  
  CONCLUSIONS
  Vertebral osteomyelitis may be caused by direct spread following an oesophageal procedure. Microbiological diagnosis is essential to target the specific pathogen, especially in cases of polymicrobial infection.
authors.affiliation: Infectious Disease Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. aude.giger@chuv.ch.
authors.forename: Aude
authors.initials: A
authors.lastname: Giger
authors.affiliation: Laboratory Medicine, Gasthuiszusters Antwerpen Hospital, Antwerpen, Belgium.
authors.forename: Erlangga
authors.initials: E
authors.lastname: Yusuf
authors.affiliation: Infectious Disease Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Oriol
authors.initials: O
authors.lastname: Manuel
authors.affiliation: Department of Medicine, Neuchâtel cantonal Hospital, Neuchâtel, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Clerc
authors.affiliation: Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification; D058834:Gemella / Q000302:isolation & purification; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging; D034361:Streptococcus mitis / Q000302:isolation & purification; D013904:Thoracic Vertebrae / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Mixed infections; Postinterventional osteomyelitis; Spondylodiscitis