Vertebral Osteomyelitis Caused byMycobacterium abscessusSurgically Treated Using Antibacterial Iodine-Supported Instrumentation

Abstract

Mycobacterium abscessusinfections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due toMycobacterium abscessusis very rare and only three previous cases of spinal infection caused byMycobacterium abscessushave been reported.Mycobacterium abscessusisolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealedMycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective toMycobacterium abscessusafter surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.