Abstract
Vertebral osteomyelitis and epidural abscess caused by Nocardia brasiliensis is very rare. This report states the successful treatment of Nocardial vertebral osteomyelitis and epidural abscess of the thoracic spine. A 56-year-old Thai female presented with pulmonary nocardiosis and sudden paraplegia. Her underlying disease was Evans syndrome (immunocompromised host). Her physical examination and investigation showed vertebral osteomyelitis and a spinal epidural abscess, which was compressing her spinal cord (T4- T7). Culture pus and tissue specimens from the epidural spine were reported as Nocardia brasiliensis. The patient underwent standard treatment for vertebral osteomyelitis and epidural abscess by surgical decompression, debridement and prolonged antibiotic therapy with intravenous Bactrim (trimethoprimsulfamethoxazole (TMP-SMX)) for a total of 2 weeks, and then continued with oral Bactrim for 12 months. The patient’s neurological status had significantly improved at a 12-month follow-up. Nocardia brasiliensis osteomyelitis and epidural abscess are very challenging in their management. However, early investigation for diagnosis, followed by medical and surgical treatment they can have a successful outcome.
Highlights
The most common organism causing vertebral osteomyelitis is Staphylococcus aureus that results from hematogenous spread [1]
Nocardia species are included in the actinomycetes group
A 56-year-old female was diagnosed with Evans syndrome and was on a high dose of prednisolone for 4 years
Summary
The most common organism causing vertebral osteomyelitis is Staphylococcus aureus that results from hematogenous spread [1]. A 56-year-old female was diagnosed with Evans syndrome and was on a high dose of prednisolone for 4 years At this visit, she presented with a cough and had had dyspnea for 3 weeks. She presented with a cough and had had dyspnea for 3 weeks Her chest X-ray showed a heterogeneous wedge-shaped opacity, at the right middle lung field, with a size of about 4.1x7.1 cm (Figure 1A) with adjacent pleural thickening. She was diagnosed with pneumonia, partially treated with antibiotics but did not recover at the local hospital. The MRI was disseminated in nocardiasis, involving the lungs, subcutaneous tissue with left paraspinal and epidural extension, resulting in spinal cord compression from T4-T7 (Figure 2). The patient’s neurological status significantly improved at a 12-month follow-up
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