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Nocardia farcinica spinal osteomyelitis
Harm C A Graat1, André Van Ooij, Gregory A Day
1Department of Orthopaedic Surgery, University Hospital Maastricht, The Netherlands.
Spine
|May 11, 2002
Summary
This case report details the successful treatment of disseminated Nocardia farcinica spinal osteomyelitis using a combination of antibiotics, debridement, and spinal instrumentation. The patient achieved a favorable outcome with independent ambulation after 3 years.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Orthopedic Surgery
Background:
- Nocardia spinal osteomyelitis is rare, with only 11 cases of Nocardia asteroides reported in 40 years.
- Nocardia farcinica spinal osteomyelitis is exceptionally uncommon, with this study reporting the first case.
Observation:
- A 54-year-old male presented with disseminated Nocardia farcinica infection, including extensive spinal osteomyelitis, epidural abscesses, discitis, and cerebral abscesses.
- The patient exhibited symptoms of low back pain, fever, and dementia, indicating a severe systemic infection.
Findings:
- A treatment regimen combining antibiotics, surgical debridement, and posterior spinal instrumentation was implemented.
- The patient demonstrated significant recovery, achieving independence and ambulation at a 3-year follow-up, with a 5-month cessation of antibiotics.
Implications:
- This case suggests that aggressive surgical intervention, including spinal instrumentation, alongside antibiotic therapy, can lead to favorable outcomes in Nocardia spinal osteomyelitis.
- The findings propose a viable treatment strategy for this rare and severe infection, potentially improving patient prognosis and recovery compared to historical approaches.