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

ABSTRACT

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.