Diagnosis and treatment of Fusobacterium nucleatum discitis and vertebral osteomyelitis: case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: We present a case of vertebral osteomyelitis and discitis caused by Fusobacterium nucleatum in a 42-year-old female. SUMMARY OF BACKGROUND DATA: Infection of the vertebral bodies or disc space with this organism is rare. A review of the English literature disclosed 13 cases of vertebral osteomyelitis caused by Fusobacterium spp. Because of the negative impact of this condition on the affected patients' activities of daily living, it is important to understand the clinical character and effective management of the disease to improve quality of life. Fusobacterium is an anaerobic and gram-negative microbe that is part of the normal flora of the mouth, gastrointestinal tract, and female genital tract. It is the main cause of Lemierre syndrome and has also been seen in septicemia. METHODS: The patient presented to our institution with a 3-month history of severe lower back pain. Her back pain was diagnosed as vertebral osteomyelitis. Magnetic resonance images of the lumbar spine revealed decreased T2 signal in the L3 and L4 vertebral bodies. Computed tomographic scan demonstrated asymmetrical disc height loss between vertebral bodies L3 and L4 and associated periosteal reaction. RESULTS: Computed tomography-guided biopsy of vertebral bodies L3 and L4 revealed microorganism Fusobacterium nucleatum with the following in vitro susceptibilities: clindamycin ≤0.5 S, metronidazole ≤0.5 S, penicillin ≤0.5 S, ertapenem ≤4 S. Parenteral ertapenem, at a dose of 1 g every 24 hours for 8 weeks in combination with oral amoxicillin and clavulanate as oral suppression was used as medical management. At 1-month follow-up after medical treatment, the patient's inflammatory markers returned to normal values, and the infection resolved with L3-L4 autofusion. CONCLUSION: We report a rare case of Fusobacterium vertebral osteomyelitis. This condition is associated with several comorbid and concomitant conditions including gastrointestinal complications. Effective treatment includes thoracolumbar orthosis bracing and intravenous antibiotic therapy.

Trombosis de la vena yugular interna y mediastinitis aguda necrosante descendente debido a una faringoamigdalitis aguda / Thrombosis of the internal jugular vein and descending necrotizing mediastinitis due to acute pharyngotonsilitis

El síndrome de Lemierre es una patología muy infrecuente en la época actual, pero muy grave, y siempre debe considerarse ante un cuadro de fiebre con antecedente de infección orofaríngea, tumefacción laterocervical a lo largo del músculo esternocleidomastoideo y signos de sepsis. El diagnóstico de este síndrome es fundamentalmente clínico, y las pruebas complementarias tan sólo ayudan a confirmar el cuadro. Presentamos el caso de un varón de 31 años que acudió a urgencias con clínica de faringoamigdalitis junto con tumefacción en la región submandibular izquierda e importante dolor cervical ipsilateral, que mostró un deterioro rápido y progresivo del estado general pese al tratamiento antibiótico intravenoso. Finalmente tuvo que ser intervenido debido al desarrollo de mediastinitis aguda necrosante descendente desde la región pretiroidea hasta el diafragma, con trombosis de la vena yugular interna izquierda. Se le realizó toracotomía urgente y cervicotomía izquierda con drenaje de abundante material purulento y ligadura de la vena yugular interna(AU)

Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The diagnosis of this syndrome is mainly clinical and complementary test only serve as aid to confirm it. We report an unusual case of Lemierre syndrome in a 31-year-old man caused by Gemella spp. and Streptococcus pyogenes. It developed following a pharyngotonsillitis infection, which deteriorated rapidly and progressively despite intravenous antibiotic treatment. He finally had to be intervened due to developing acute descending necrotizing mediastinitis from the pre-thyroid region to the diaphragm, with thrombosis of the internal jugular vein. An urgent thoracotomy and left cervicotomy was performed, with drainage of abundant purulent material and ligature of the internal jugular vein. We also discuss its atypical clinical presentation, the crucial role of imaging in the early diagnosis, and the different treatment options of this life-threatening syndrome(AU)