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Postoperative Spine Infection - Postoperative MRSA Infection in a Wrongly Diagnosed Case of Spine Trauma
1Department of Spine, Aster MIMS Hospital, Govindapurasam, Calicut, Kerala, India.
Introduction:
Pathological fractures resulting from trivial trauma may be overlooked, especially, when it is after a road traffic accident.
Case Report:
A 56-year-old male was operated elsewhere for burst fracture L3 vertebra following a trivial road traffic accident. Due to the persistence of symptoms, he was reevaluated. Magnetic resonance imaging revealed infection at the operated site. The implants were removed, pus drained, and a transpedicular biopsy was taken from L3 vertebral body along with bone marrow aspirate from the iliac crest, suspecting a pathological fracture. He was diagnosed to have multiple myeloma and was treated in consultation with medical oncology department. His spine was stabilized 6 weeks later when the infection healed. He was further treated at the medical oncology department for multiple myeloma. Then, he developed infection again and underwent implant removal and wound debridement. 3 weeks later, he developed electrolyte imbalance and infection and succumbed to the disease.
Conclusion:
Pathological fracture should be suspected in fractures resulting from trivial trauma. Multiple myeloma patients have a higher chance of infection with MRSA. With chemotherapy, the immunity goes further down resulting in florid infection.
Insights
Pathological fractures from minor trauma can be missed, especially after accidents. Multiple myeloma patients face increased infection risk, leading to severe complications, even with treatment.
Area of Science:
- Orthopedic Surgery
- Oncology
- Infectious Diseases
Background:
- Pathological fractures from minor trauma can be misdiagnosed, particularly following road traffic accidents.
- Early suspicion is crucial for timely diagnosis and appropriate management.
Observation:
- A 56-year-old male with a burst L3 vertebra fracture post-accident developed persistent symptoms.
- Re-evaluation revealed surgical site infection, leading to diagnosis of multiple myeloma.
- The patient experienced recurrent infections and complications despite treatment, ultimately succumbing to the disease.
Findings:
- Multiple myeloma is associated with an increased risk of infection, including Methicillin-resistant Staphylococcus aureus (MRSA).
- Chemotherapy for multiple myeloma can further compromise immunity, exacerbating infectious processes.
- Pathological fractures require high clinical suspicion, especially in trauma patients with underlying conditions.
Implications:
- Emphasizes the need for vigilance in diagnosing pathological fractures in trauma settings.
- Highlights the significant risk of severe infections in multiple myeloma patients undergoing chemotherapy.
- Underscores the importance of multidisciplinary care involving oncology, infectious disease, and orthopedic surgery.
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