Abstract
BackgroundProteus mirabilis is the second most common pathogen that causes urinary tract infections after Escherichia coli. In rare cases, it is associated with vertebral osteomyelitis. The underlying mechanism of this relationship may be related to the retrograde dissemination of bacteria through the paravertebral venous plexus.Case presentationWe report a case of an 80-year-old Taiwanese woman who had recurrent episodes of fever and chronic back pain for 1 year. All blood cultures were positive for P. mirabilis. Inflammation scans and magnetic resonance imaging revealed a previously undetected vertebral lesion between the seventh and eighth thoracic vertebra. She responded well to treatment with antibiotics, reporting considerable relief of back pain and no fever recurrence at the 4-month follow-up.ConclusionsChronic back pain is a common but often dismissed symptom among the older population; osteomyelitis should be considered in patients with recurrent fever or neurological symptoms. Old age, chronic renal failure, and diabetes mellitus are possible predisposing factors for osteomyelitis. Our findings suggest that long-term treatment with antibiotics is effective for osteomyelitis caused by P. mirabilis,, although surgery is required for abscess formation or serious vertebral destruction.
Highlights
ConclusionsChronic back pain is a common but often dismissed symptom among the older population; osteo‐ myelitis should be considered in patients with recurrent fever or neurological symptoms
Proteus mirabilis is the second most common pathogen that causes urinary tract infections after Escherichia coli
Our findings suggest that long-term treatment with antibiotics is effective for osteomyelitis caused by P. mirabilis, surgery is required for abscess formation or serious vertebral destruction
Summary
Because chronic back pain in the older adult population is often dismissed as a common ailment, the diagnosis of spondylodiscitis requires a high index of suspicion. Physicians should consider the possibility of undiscovered osteomyelitis when the patient presents with concurrent neurologic symptoms and bacteremia. Once TB osteomyelitis is ruled out, pyogenic osteomyelitis of other pathogens should be considered. Vertebral osteomyelitis caused by P. mirabilis is extremely rare, and old age, chronic renal failure, and diabetes mellitus are possible predisposing factors. Previous case reports have indicated recurrent UTI episodes despite sufficient antibiotic treatment; this symptom, along with the presence of permanent indwelling urinary catheter, should alert clinicians to the possibility of causative pathogenic organisms other than S. aureus [2]. Vertebral osteomyelitis caused by P. mirabilis can be sufficiently treated with long-term antibiotics administrations; the duration of treatment was around 4 months in the present case, with intravenous injection for the first 3 weeks and oral admission for the remainder of treatment.
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