Emphysematous osteomyelitis of the spine: a case report and case based review of the literature.
Emphysematous osteomyelitis of the spine: a case report and case based review of the literature.
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DOI：
10.21037/jss-22-6
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发表时间：
2022-09
期刊：
影响因子：
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通讯作者：
Gjolaj, Joseph P
中科院分区：
文献类型：
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作者：
Lee, Danny;Mohile, Neil;Rakoczy, Kyla;Gjolaj, Joseph P
脊柱的肺气肿骨髓炎(EO)是一种罕见的骨髓炎类型，其特征是椎骨内气体形成。本报告的目的是提出一例罕见的脊椎EO患者的肺气肿膀胱炎。对脊椎EO的文献也进行了基于病例的回顾，以更新这种罕见感染的相关文献。一位55岁女性，患有糖尿病及外周血管病变(PVD)，因反复跌倒、疲乏及腰背痛而来本院就诊。计算机断层扫描(CT)和核磁共振成像(MRI)扫描证实了L4的肺气肿性膀胱炎和EO。考虑到弥漫性参与，手术干预推迟到静脉注射抗生素治疗。在Scope us和PubMed数据库中搜索“肺气肿骨髓炎”、“GAS”和“脊柱”，也进行了基于病例的综述。这次审查只包括英文出版物。尿/血培养鉴定为肺炎克雷伯菌。经过6周的广谱抗生素的初步改善，患者再次出现反复发烧和疲劳。尽管接受了最大限度的药物治疗，但患者在2个月后因多器官系统衰竭而死亡。包括本报告在内，文献中仅描述了29例脊柱EO。患者几乎始终如一地表现为发热、炎症标志物升高和局限性疼痛。脊髓EO多为单菌感染(89.7%)。病原菌以大肠埃希菌(37.9%)和肺炎克雷伯菌(27.6%)为主。在裁剪之前，医疗治疗普遍包括广谱静脉注射抗生素。清创和减压，无论有无融合，是脊柱EO的主要手术程序。脊柱EO的结果各不相同，死亡率为44.4%。我们提出了一例脊柱上皮样病变并伴有肺气肿的肺炎克雷伯菌膀胱炎的病例，并对文献进行了病例回顾。对于这种罕见的感染，适当的检查应该包括炎症标志物、培养和CT/MRI成像。治疗包括静脉注射抗生素，厌氧和革兰氏阴性覆盖。然而，脊椎气肿性骨髓炎的治疗指南和手术指征仍不清楚。
Emphysematous osteomyelitis (EO) of the spine is an uncommon type of osteomyelitis characterized by intraosseous gas-formation in the vertebrae. The objective of this report is to present a rare case of spine EO in a patient with emphysematous cystitis. A case-based review of the literature on spinal EO was also performed as an update to the relevant literature of this rare infection. A 55-year-old female with diabetes mellitus and peripheral vascular disease (PVD) presented to our institution with recurrent falls, fatigue, and low back pain. Computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed emphysematous cystitis and EO at L4. Given the diffuse involvement, surgical intervention was deferred for IV antibiotic therapy. A case-based review was also conducted by searching the SCOPUS and PubMed databases for the following terms: “emphysematous osteomyelitis”, “gas”, and “spine”. Only publications in English were included in this review. Urine/blood cultures identified Klebsiella pneumoniae. After initial improvement with six weeks of broad-spectrum antibiotics, the patient re-presented with recurrent fevers and fatigue. Despite maximal medical therapy, the patient expired 2 months later due to multi-organ system failure. Including the present report, only 29 cases of spine EO have been described in the literature. Patients almost consistently presented with fever, elevated inflammatory markers, and localized pain. Most cases of spinal EO (89.7%) were monomicrobial. Escherichia coli (37.9%) and Klebsiella pneumoniae (27.6%) were the most causative organisms identified. Medical treatment universally consisted of broad-spectrum IV antibiotics prior to tailoring. Debridement and decompression, with or without fusion, were the main operative procedures performed for spine EO. Outcomes following spinal EO are varied with a 44.4% mortality rate. We present a case of EO of the spine and concomitant emphysematous cystitis with Klebsiella pneumoniae and a case-based review of the literature. Appropriate work up for this rare infection should include inflammatory markers, cultures, and CT/MRI imaging. Treatment consists of IV antibiotics with anaerobic and gram-negative coverage. However, treatment guidelines and operative indications for spinal emphysematous osteomyelitis remain unclear.