PDF(Pubmed)
Abstract：
BACKGROUND: Pyogenic spondylodiscitis is an infectious spinal disease that causes significant motor dysfunctions. Its diagnosis can be challenging owing to its rapid onset and nonspecific symptoms.
METHODS: A 79-year-old Japanese man with a history of type 2 diabetes mellitus and polymyalgia rheumatica presented to our department with tongue pain. Following partial glossectomy and wisdom tooth extraction under general anesthesia, on 10 postoperative day (POD) the patient developed right-sided abdominal pain and difficulty in walking. On 12 POD, the patient was admitted to a municipal hospital due to respiratory distress and paraplegia.
METHODS: The patient was diagnosed with pyogenic spondylodiscitis and empyema. Blood tests revealed elevated C-reactive protein levels (36.5), white blood cell count (19,570), and neutrophil count (17,867).
METHODS: The patient received meropenem hydrate 3 g/2 days as empiric antibiotic treatment for acute infection. Upon admission to the emergency department on 16 POD, the lung abscess was drained, hemilaminectomy was performed.
RESULTS: Blood cultures, sputum tests, and cultures from the thoracic and spinal abscesses drained during surgery revealed methicillin-sensitive Staphylococcus aureus. The infection was successfully managed, and the respiratory disturbance and inflammatory response improved. However, the lower half of the patient body remained paralyzed. Subsequently, the patient was transferred to a rehabilitation facility on 45 POD. The patient continued to undergo functional restoration training, gradually regained function, and eventually achieved the ability to walk with grasping gait.
CONCLUSIONS: This is the first case report of S aureus causing pyogenic spondylodiscitis and empyema due to blood stream infection from a post-oral surgical wound. Pyogenic spondylodiscitis arising from a secondary hematogenous infection is difficult to diagnose and can lead to severe functional impairment. Prompt and appropriate diagnosis and treatment based on detailed patient interviews, additional blood tests, and computed tomography are essential.
METHODS: A 79-year-old Japanese man with a history of type 2 diabetes mellitus and polymyalgia rheumatica presented to our department with tongue pain. Following partial glossectomy and wisdom tooth extraction under general anesthesia, on 10 postoperative day (POD) the patient developed right-sided abdominal pain and difficulty in walking. On 12 POD, the patient was admitted to a municipal hospital due to respiratory distress and paraplegia.
METHODS: The patient was diagnosed with pyogenic spondylodiscitis and empyema. Blood tests revealed elevated C-reactive protein levels (36.5), white blood cell count (19,570), and neutrophil count (17,867).
METHODS: The patient received meropenem hydrate 3 g/2 days as empiric antibiotic treatment for acute infection. Upon admission to the emergency department on 16 POD, the lung abscess was drained, hemilaminectomy was performed.
RESULTS: Blood cultures, sputum tests, and cultures from the thoracic and spinal abscesses drained during surgery revealed methicillin-sensitive Staphylococcus aureus. The infection was successfully managed, and the respiratory disturbance and inflammatory response improved. However, the lower half of the patient body remained paralyzed. Subsequently, the patient was transferred to a rehabilitation facility on 45 POD. The patient continued to undergo functional restoration training, gradually regained function, and eventually achieved the ability to walk with grasping gait.
CONCLUSIONS: This is the first case report of S aureus causing pyogenic spondylodiscitis and empyema due to blood stream infection from a post-oral surgical wound. Pyogenic spondylodiscitis arising from a secondary hematogenous infection is difficult to diagnose and can lead to severe functional impairment. Prompt and appropriate diagnosis and treatment based on detailed patient interviews, additional blood tests, and computed tomography are essential.
摘要：
背景：化脓性脊柱盘炎是一种感染性脊柱疾病，可引起严重的运动障碍。由于其快速发作和非特异性症状，其诊断可能具有挑战性。
方法：一名79岁的日本男子，有2型糖尿病和风湿性多肌痛病史，出现舌痛。在全身麻醉下进行部分舌状切除术和智齿拔除后，术后10天（POD），患者出现右侧腹痛和行走困难。在12POD上，该患者因呼吸窘迫和截瘫而被送往市立医院。
方法：患者被诊断为化脓性脊柱盘炎和脓胸。血液检查显示C反应蛋白水平升高（36.5），白细胞计数（19,570），和中性粒细胞计数（17,867）。
方法：患者接受3g/2天的美罗培南水合物作为急性感染的经验性抗生素治疗。16POD入住急诊科后，肺脓肿被引流,进行了半椎板切除术。
结果：血培养，痰检,手术期间引流的胸脓肿和脊柱脓肿的培养物显示甲氧西林敏感的金黄色葡萄球菌。成功控制了感染,呼吸障碍和炎症反应得到改善。然而,患者身体的下半部分仍然瘫痪。随后，患者在45POD时被转移到康复机构.病人继续接受功能恢复训练,逐渐恢复功能，并最终实现了以抓步态行走的能力。
结论：这是首例金黄色葡萄球菌由于口腔手术后伤口的血流感染引起化脓性脊柱盘炎和脓胸的病例报告。继发血源性感染引起的化脓性脊柱盘炎难以诊断，并可导致严重的功能障碍。根据详细的患者访谈进行及时和适当的诊断和治疗，额外的血液测试，计算机断层扫描是必不可少的。
方法：一名79岁的日本男子，有2型糖尿病和风湿性多肌痛病史，出现舌痛。在全身麻醉下进行部分舌状切除术和智齿拔除后，术后10天（POD），患者出现右侧腹痛和行走困难。在12POD上，该患者因呼吸窘迫和截瘫而被送往市立医院。
方法：患者被诊断为化脓性脊柱盘炎和脓胸。血液检查显示C反应蛋白水平升高（36.5），白细胞计数（19,570），和中性粒细胞计数（17,867）。
方法：患者接受3g/2天的美罗培南水合物作为急性感染的经验性抗生素治疗。16POD入住急诊科后，肺脓肿被引流,进行了半椎板切除术。
结果：血培养，痰检,手术期间引流的胸脓肿和脊柱脓肿的培养物显示甲氧西林敏感的金黄色葡萄球菌。成功控制了感染,呼吸障碍和炎症反应得到改善。然而,患者身体的下半部分仍然瘫痪。随后，患者在45POD时被转移到康复机构.病人继续接受功能恢复训练,逐渐恢复功能，并最终实现了以抓步态行走的能力。
结论：这是首例金黄色葡萄球菌由于口腔手术后伤口的血流感染引起化脓性脊柱盘炎和脓胸的病例报告。继发血源性感染引起的化脓性脊柱盘炎难以诊断，并可导致严重的功能障碍。根据详细的患者访谈进行及时和适当的诊断和治疗，额外的血液测试，计算机断层扫描是必不可少的。
