Surgery Today

, Volume 42, Issue 10, pp 1022–1025 | Cite as

Pyogenic vertebral osteomyelitis in a breast cancer patient: report of a case

  • Hisamitsu Zaha
  • Mai Onomura
  • Yukiko Nishikuramori
Case Report


We herein report a rare case of pyogenic vertebral osteomyelitis (PVO) coexisting with breast carcinoma. A 71-year-old female presented with neck pain without fever. Magnetic resonance imaging (MRI) showed suspected metastatic lesions in her neck (C7 and Th1). Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased FDG uptake in the neck spines and in the left breast. A core needle biopsy of the left breast revealed the presence of invasive ductal carcinoma. Our first tentative diagnosis of the patient was left breast carcinoma with bone metastases, and first-line endocrine therapy was started. However, surgical intervention for the spines had to be considered, because her neurological symptoms progressed. A repeated MRI scan showed a narrowing of the disc space and fluid accumulation around the vertebrae. This suggested the presence of PVO rather than metastases. Surgery confirmed the presence of PVO in C7 and Th1, and a culture of the abscess yielded Escherichia coli. The patient’s neurological symptoms dramatically improved after surgery. Breast conserving surgery was performed 3 months after the surgery for PVO. The patient is well and has no clinical evidence of disease 18 months after the breast conserving surgery. PVO is rare, but should be included in the differential diagnosis in patients presenting with early breast carcinoma.


Pyogenic osteomyelitis Bone metastasis Breast cancer 


Conflict of interest

Hisamitsu Zaha and co-authors have no conflict of interest.


  1. 1.
    Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009;39(1):10–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65 Suppl 3:iii11–24.Google Scholar
  3. 3.
    Voravud N, Theriault R, Hortobagyi G. Vertebral osteomyelitis mimicking bone metastasis in breast cancer patients. Am J Clin Oncol. 1992;15(5):428–32.CrossRefPubMedGoogle Scholar
  4. 4.
    Khan IA, Vaccari AR, Zlotolw DA. Management of vertebral diskitis and osteomyelitis. Orthopedics. 1999;22(8):758–65.PubMedGoogle Scholar
  5. 5.
    Goldrick A, Harnett PR. Vertebral osteomyelitis in advanced breast cancer. Aust N Z J Med. 1993;23(4):406.CrossRefPubMedGoogle Scholar
  6. 6.
    Balériaux DL, Neugroschl C. Spinal and spinal cord infection. Eur Radiol. 2004;14 Suppl 3: E72–83 (review).Google Scholar
  7. 7.
    Adams JE, Isherwood I. Conventional and new techniques in radiological diagnosis. In: Stoll BA, Parbhoo S, editors. Bone metastasis: monitoring and treatment. New York: Raven Press, Ltd.; 1983. p. 107–48.Google Scholar
  8. 8.
    Norman A, Kambolis CP. Tumors of the spine and their relationship to the intervertebral disc. AJR. 1964;92:1270–4.Google Scholar
  9. 9.
    Easton EJ, Powers JA. The spine. In: Thorofare NJ, editor. Musculoskeletal magnetic resonance imaging. New Jersey: Slack Inc.; 1986. p. 93–121.Google Scholar
  10. 10.
    Dagimanjian A, Schils J, McHenry MC, Modic MT. MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol. 1996;167:1539–43.CrossRefGoogle Scholar
  11. 11.
    Schmitz A, Risse JH, Grünwald F, Gassel F, Biersack HJ, Schmitt O. Fluorine-18 fluorodeoxyglucose positron emission tomography findings in spondylitis: preliminary results. Eur Spine J. 2001;10(6):534–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stumpe KD, Zanetti M, Weishaupt D, Hodler J, Boos N, Von Schulthess GK. FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol. 2002;179(5):1151–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • Hisamitsu Zaha
    • 1
  • Mai Onomura
    • 1
  • Yukiko Nishikuramori
    • 2
  1. 1.Department of Breast SurgeryNakagami HospitalOkinawaJapan
  2. 2.Department of RadiologyNakagami HospitalOkinawaJapan

Personalised recommendations