Spondylodiscitis secondary to Mycobacterium chelonae: a case report

Background: Spondylodiscitis secondary to Mycobacterium chelonae (M. chelonae) is a rare primary infection of the spine, with a few case reports highlighted. Treatment of this infection is not well established but here we discuss a case where a patient recovered well following early aggressive surgical intervention and antibiotic treatment.

Case description: A 32-year-old male presented with a 3-month history of worsening low back pain, Horner's syndrome, dysphagia, lower extremity weakness, and a 5-day history of bowel and bladder incontinence. The patient had an extensive orthopedic history but no recent trauma or history of spinal surgery. He had no known prior medical conditions that would suggest immunocompromise. Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood cultures did not show any growth. The patient underwent L4-S1 decompression and fusion with iliac crest bone grafting, and intraoperative biopsy. Intraoperative tissue cultures grew M. chelonae. Repeat computerized tomography (CT)-guided biopsy confirmed the pathogen. The patient was initially treated with vancomycin and piperacillin-tazobactam. Numerous alterations in antibiotic regimen occurred secondary to medication adverse effects and noncompliance, and he was ultimately treated with azithromycin and tigecycline. Interval follow-up demonstrated gradual improvement of bilateral lower extremity strength and return of bowel and bladder function. Follow-up at 16 months post-operatively demonstrated significant improvement in pain and neurological symptoms, with no signs of infection recurrence.

Conclusions: This case demonstrates the importance of aggressive surgical management of M. chelonae spondylodiscitis. Early aggressive surgical management in combination with antibiotics may improve clinical outcomes for these patients.