Vertebral Osteomyelitis Due to Mycobacterium abscessus in an HIV-Negative Patient: Case Report and Literature Review

Abstract

Atypical mycobacteria are an extremely rare cause of vertebral infection. Review of the English literature by use of MEDLINE from 1955 to 2012 revealed less than 50 cases of vertebral osteomyelitis due to atypical mycobacteria. Three of these cases were due to Mycobacterium abscessus. Infection of the musculoskeletal system with atypical mycobacterium usually involves tenosynovitis and occurs from either percutaneous inoculation or hematogenous spreading. The clinical course is indolent, slowly progressive, and destructive. Most cases were immunocompetent hosts. This presented case de- monstrated vertebral osteomyelitis due to M. abscessus in an HIV-negative patient without history of any underlying diseases or trauma before having this infection. There are no consensus guidelines for the treatment of these infections. Treatment of these infections is difficult and requires a prolonged course of combination antimicrobial agents. Antimycobacterial treatments for infection due to M. abscessus are based on case series, in vitro susceptibility testing and the clinical experience of experts in patients with pulmonary diseases. Surgery is generally indicated with extensive cutaneous diseases, abscess formation or where drug therapy is difficult. Keywords: Vertebral osteomyeltis, Mycobacterium abscessus Siriraj Med J 2014;66:49-52