rifampin and Intervertebral-Disc-Displacement

Postoperative spondylodiscitis (PSD) is a known complication of lumbar disc surgery. The etiology of the disease is usually bacterial, but several uncommon infectious agents have also been described; however, there are no reports about postoperative colonization with Mycobacterium bovis bacille Calmette-Guérin after lumbar discectomy.. To describe the case of PSD caused by M. bovis BCG, and to discuss diagnostic and therapeutic interventions as well as possible pathogenic mechanisms of the disease.. Case report and review of the literature.. A 31-year-old man was operated on because of L4-L5 lumbar disc herniation. Two months later, the patient presented with gradual increase of back pain, and magnetic resonance imaging confirmed PSD. He started to receive antibacterial treatment and was reoperated on because of progressive neurological deficits due to epidural abscess. Neurological status improved, but a fistula developed with intermittent pus drainage from the operative scar.. Microbiological cultures were repeatedly obtained from the pus, but all the initial stains and cultures were negative. Four months after the reoperation, the culture for M. bovis BCG from the pus appeared to be positive. The patient received antituberculosis regimen, including isoniazid, rifampin, ethambutol, and ofloxacin. The clinical symptoms resolved, and antituberculosis treatment was discontinued after 14 months.. Mycobacterium bovis BCG must be considered in the differential diagnosis of PSD. Microbiological analysis and radiological studies are vital components in diagnosis; if there is any suspicion of BCG osteomyelitis, proper diagnostic and therapeutic management must be instituted without delay to avoid an unfavorable outcome.

Topics: Antitubercular Agents; Discitis; Diskectomy; Epidural Abscess; Humans; Intervertebral Disc Displacement; Isoniazid; Lumbar Vertebrae; Male; Mycobacterium bovis; Postoperative Period; Rifampin; Treatment Outcome; Tuberculosis

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Discitis; Drug Therapy, Combination; Epidural Abscess; Humans; Intervertebral Disc Displacement; Kingella kingae; Low Back Pain; Male; Neisseriaceae Infections; Ofloxacin; Rifampin; Spinal Neoplasms

The adequate treatment of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis has intrigued clinicians for some time. As the resistance of these pathogens, coupled with the increase in community-acquired cases, continues steadily to rise, clinicians are finding it useful to employ multi-modal approaches for efficacious treatment. The authors present a single case report of a patient with recurrent MRSA osteomyelitis, lumbar paraspinal and epidural abscess. He was found to have decreased muscle strength and was hyporeflexic in the involved extremity. Serum testing demonstrated MRSA bacteremia. Neuroimaging studies revealed evidence of paraspinal abscess and a presumed herniated nucleus pulposus at the L5/S1 interspace with significant nerve root compromise. Despite antimicrobials, his symptoms persisted, necessitating surgical exploration. At surgery, paraspinal and epidural abscesses were encountered and debrided; however, no herniated disc was visualized. This case demonstrates the diagnostic and therapeutic dilemmas with which these lesions present. We postulate that the MRSA osteomyelitis/discitis pathogens were walled off in the disc space and subsequently inoculated the soft tissues with ensuing bacteremia. We concur that antimicrobial treatment should be the first line of therapy for these patients; however, surgical debridements and cautious spinal instrumentation should be employed where appropriate.

Topics: Abscess; Acetamides; Adult; Anti-Bacterial Agents; Bacteremia; Debridement; Drug Therapy, Combination; Humans; Intervertebral Disc Displacement; Laminectomy; Linezolid; Lumbar Vertebrae; Male; Methicillin Resistance; Osteomyelitis; Oxazolidinones; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Treatment Outcome; Vancomycin

Topics: Cervical Vertebrae; Humans; Intervertebral Disc Displacement; Osteomyelitis; Rifampin