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Thoracic Spondylitis From a Mycotic (Streptococcus pneumoniae) Aortic Aneurysm: A Case Report

Englert, Carsten, MD*; Aebert, Hermann, MD; Lenhart, Markus, MD; Solleder, Albert, MD*; Nerlich, Michael, MD*; Neumann, Carsten, MD*

doi: 10.1097/01.brs.0000137061.79898.8f
Case Reports
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Study Design. We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described.

Summary of Background Data. Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies.

Methods. The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 × 0.5 g/day, Cefotaxim 3 × 2 g/day, and Flucloxacillin 3 × 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter.

Results. The patient made a good recovery and is free of recurrence 4 years after surgery.

Conclusions. Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.

Spondylitis by Streptococcus pneumoniae combined with mycotic aneurysm has a low incidence but a high mortality. Complicating fistula to the lung with successful treatment has not been described. This case report deals with the operative medical treatment with long-term survival.

From the *Department of Trauma and Reconstructive Surgery, University of Regensburg Hospital, Regensburg, Germany; †Department of Thoracic and Cardiovascular Surgery, Eberhard Karls University, Tübingen, Germany; and ‡Department of Radiology, University of Regensburg Hospital, Regensburg, Germany.

Acknowledgment date: July 14, 2003. Revision date: October 17, 2003. Acceptance date: December 1, 2003.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Carsten Englert, MD, Department of Trauma and Reconstructive Surgery, University of Regensburg Hospital, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; E-mail: Carsten.Englert@klinik.uni-regensburg.de

© 2004 Lippincott Williams & Wilkins, Inc.