[Lumbar osteomyelitis of actinomycotic or atypical mycobacterial origin?]

A case of lumbar epiduro-vertebral actinomycosis is related, in a 45 years old man, who was immuno depressed by an evolutive pulmonary sarcoidosis. 72 similar cases are reported in the literature. 50 of them are autopsied++. Clinically our patient looked like a Pott disease. The infection began probably in the kidney. The smear's diagnosis was actinomycosis, confirmed by the routine examination. An atypical mycobacteria, Mycobacterium xenopi was bacteriologically isolated twice in the pus. It was considered as the pathogen agent for 14 months. Actinomycosis was never identified bacteriologically. The patient responded to surgery and penicillin therapy. In view of the pathologic constatations and the therapeutic response, the final diagnostic was epiduro-vertebral actinomycosis. Mycobacterium xenopi acted probably as an "accompaning " germ in this case.