Vertebral Osteomyelitis in Pregnancy from a Methicillin-resistant Staphylococcus Aureus Vulvar Abscess. A Case Report

Osteomyelitis is a rare problem in pregnancy but can present challenges for diagnosis and treatment. This case report describes a patient with a history of vulvar abscess who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and osteomyelitis during pregnancy.

A 20-year-old woman, gravida 1, at 33 weeks' gestation, developed sepsis from MRSA bacteremia after a vulvar abscess drainage. She developed acute respiratory distress syndrome (ARDS) and was found to have osteomyelitis on her thoracic spine level 7. The diagnosis of osteomyelitis was based on clinical findings and magnetic resonance imaging. An emergent cesarean section was undertaken due to worsening ARDS. The osteomyelitis was treated with intravenous daptomycin with symptomatic improvement. However, back pain returned and the patient was readmitted and required a spinal brace and 6 weeks of intravenous vancomycin.

Osteomyelitis in pregnancy is a rare complication and a challenging diagnosis that requires a high index of suspicion. The treatment of osteomyelitis in pregnancy versus nonpregnancy is the same. This case is unique because this pregnant patient developed osteomyelitis secondary to a vulvar abscess.