Piomiositis y espondilodiscitis hematógena en un paciente inmunocompetente / Pyomiositis and hematogenous spondylodiscitis in a immunocompetent patient

Resumen:La piomiositis es una infección bacteriana primaria de músculo esquelético. Anteriormente era una enfermedad solo de pacientes de zonas de clima tropical, por lo que se conocía como piomositis tropical. No obstante, se ha dado un aumento en la aparición de casos en zonas no tropicales en especial en pacientes inmunocomprometidos. Esta condición puede asociarse a bacteremia y por ende a la aparición de focos infecciosos de diseminación hematógena. Se reporta un caso de espondilodiscitis bacteriana secundaria a bacteremia, derivada de una piomiositis de músculo iliopsoas. El paciente consulta por lumbalgia y se le diagnostica absceso en musculo psoas, el cual requirió drenaje percutáneo. No obstante, desarrolla paraplejia fláccida y se sospecha compresión medular. La tomografía espinal demuestra compresión a nivel de segmento C5-C6 secundario a espondilodiscitis, que precisó tratamiento quirúrgico y drenaje de colección.Se aisló también Staphylococcus aureus de este sitio. El caso ilustra la diseminación hematógena de una piomiositis hacia proceso vertebral con déficit neurológico, por compresión medular en un paciente inmunocompetente.

Abstract:Pyomyositis is a primary bacterial infection of skeletal muscle. Formerly, it was a disease present orly in patients in tropical climate zones, thus being known as tropical pyomyositis. Nonetheless there has been an increased incidence in non-tropical climates mainly in immunocompromised patients. This condition may be related to bacteremia and therefore to the appearance of infectious sites through hematogenous dissemination. A case of spondylodiscitis, due to bacteremia from an iliopsoas muscle pyomyositis, is reported. The patient consulted initially for severe low back pain and an abscess in the iliopsoas muscle was diagnosed and percutaneous drainage was required.Few days later, the patient suffered flaccid paralysis of both lower limbs and spinal cord compression was suspected. The spinal tomography scan showed spinal cord compression at C5-C6 level due to spondylodiscitiswhichrequired surgical treatment and drainage. A culture positive for Staphylococcus aureus was also isolated from the area.This case shows hematogenous dissemination of bacterial pyomyositis with spinal compromise and cord compression in an immunocompetent patient.

Transpedicular Curettage and Drainage of Infective Lumbar Spondylodiscitis: Technique and Clinical Results

BACKGROUND: Infective spondylodiscitis usually occurs in patients of older age, immunocompromisation, co-morbidity, and individuals suffering from an overall poor general condition unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method is needed for these select cases of infective spondylodiscitis. This retrospective clinical case series reports our novel surgical technique for the treatment of infective spondylodiscitis. METHODS: Between January 2005 and July 2011, among 48 patients who were diagnosed with pyogenic lumbar spondylodiscitis or tuberculosis lumbar spondylodiscitis, 10 patients (7 males and 3 females; 68 years and 48 to 78 years, respectively) underwent transpedicular curettage and drainage. The mean postoperative follow-up period was 29 months (range, 7 to 61 months). The pedicle screws were inserted to the adjacent healthy vertebrae in the usual manner. After insertion of pedicle screws, the drainage pedicle holes were made through pedicles of infected vertebra(e) in order to prevent possible seeding of infective emboli to the healthy vertebra, as the same instruments and utensils are used for both pedicle screws and the drainage holes. A minimum of 15,000 mL of sterilized normal saline was used for continuous irrigation through the pedicular pathways until the drained fluid looked clear. RESULTS: All patients' symptoms and inflammatory markers significantly improved clinically between postoperative 2 weeks and postoperative 3 months, and they were satisfied with their clinical results. Radiologically, all patients reached the spontaneous fusion between infected vertebrae and 3 patients had the screw pulled-out but they were clinically tolerable. CONCLUSIONS: We suggest that our method of transpedicular curettage and drainage is a useful technique in regards to the treatment of infectious spondylodiscitic patients, who could not tolerate conventional combined anterior and posterior surgery due to multiple co-morbidities, multiple level infectious lesions and poor general condition.