Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome

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• 作者：D. H. R. Kempen ; M. van Dijk ; A. I. M. Hoepelman ; F. C. Oner…
• 关键词：Lemierre syndrome ; Metastatic infection ; Vertebral osteomyelitis ; Fusobacterium species
• 刊名：European Spine Journal
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：24
• 期：4-supp
• 页码：502-507
• 全文大小：789 KB
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• 作者单位：D. H. R. Kempen (1) (2)
  M. van Dijk (1)
  A. I. M. Hoepelman (3)
  F. C. Oner (2)
  J. J. Verlaan (2)
  
  1. Department of Orthopaedics, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
  2. Department of Orthopaedics, G05.228, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
  3. Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, P.O.?Box 85500, 3508 GA, Utrecht, The Netherlands
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgical Orthopedics
  Neurosurgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-0932

文摘

Purpose To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. Methods A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin for 2?months. Two and a half months later, the patient was readmitted with severe back pain without neurological deficits or fever. Imaging revealed an extensive vertebral osteomyelitis of the complete thoracic, lumbar and sacral spine. Results Although the blood cultures obtained at the initial admission for Lemierre syndrome revealed Fusobacterium species and Streptococcus milleri, the cultures from the spinal biopsies remained negative. Histology of the spinal biopsies showed a purulent sclerosing osteomyelitis. The patient was successfully treated with intravenous piperacillin and tazobactam. Despite persisting back pain, no recurrence of infection was seen at 3?years of follow-up. Conclusion Lemierre syndrome and an extensive thoracolumbosacral vertebral osteomyelitis are rare but serious infections. Clinicians must maintain a high index of suspicion for infectious metastases leading to vertebral osteomyelitis when a patient presents with back pain after an episode of life-threatening septicaemia caused by Lemierre syndrome.