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Vertebral osteomyelitis caused by non-tuberculous mycobacteria: case reports and review


There are currently few reports of vertebral osteomyelitis caused by non-tuberculous mycobacteria. To date, only 38 cases, excluding human immunodeficiency virus patients, have been reported. We describe 3 patients with vertebral osteomyelitis caused by Mycobacterium avium-intracellulare complex or Mycobacterium kansasii, and review previous reports of vertebral osteomyelitis caused by non-tuberculous mycobacteria. Case 1 is a 50-year-old man who presented with lower back pain. Radiologic examination revealed L1–L5 enhancement and paravertebral abscess. The surgical specimen was positive for Mycobacterium avium-intracellulare complex. The patient was successfully treated by surgical excision and antibiotic administration. Case 2 is a 68-year-old woman who presented with upper back pain. Spine MRI revealed multiple lesions at T9–T12, L2, L4, and L5. Her back pain worsened, and repeated MRI revealed extensive bone lesions. Mycobacterium kansasii was isolated from a T5 vertebral body specimen. Surgery was not performed. Case 3 is a 38-year-old woman who had been taking prednisolone for systemic lupus erythematosus. We diagnosed her condition as suppurative knee arthritis caused by M. avium-intracellulare complex. Vertebral MRI revealed T9 vertebral body enhancement and a paravertebral abscess at T8–T9. Tissue culture of a T9 specimen yielded M. avium-intracellulare complex. Her clinical condition improved following posterior thoracic spinal fusion. In conclusion, vertebral osteomyelitis caused by non-tuberculous mycobacteria should be included in the differential diagnosis, even in immunocompetent patients.

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  1. 1.

    Timpe MA, Runyon EH. The relationship of “atypical” acid-fast bacteria to human disease. J Lab Clin Med. 1954;44:202–9.

    PubMed  CAS  Google Scholar 

  2. 2.

    Piersimoni C, Scarparo C. Extrapulmonary infections associated with nontuberculous mycobacteria in immunocompetent persons. Emerg Infect Dis. 2009;15:1351–8.

    PubMed  Article  Google Scholar 

  3. 3.

    Weed LA, McDonald JR, Needham GM. The isolation of saprophytic acid-fast bacilli from lesions of caseous granulomas. Proc Stull Meet Mayo Clin. 1956;31:246–59.

    CAS  Google Scholar 

  4. 4.

    Corpe RF, Smith CE, Stergus I. Death due to Mycobacterium fortuitum. JAMA. 1961;177:262–3.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Watanakunakorn C, Trott A. Vertebral osteomyelitis due to Mycobacterium kansasii. Am Rev Respir Dis. 1973;107:846–50.

    PubMed  CAS  Google Scholar 

  6. 6.

    Chusid MJ, Parrillo JE, Fauci AS. Chronic granulomatous disease. JAMA. 1975;233:1295–6.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Smith ER. Mycobacterium fortuitum spinal infection: case report. Pathology. 1976;8:289–92.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Sarria JC, Chutkan NB, Figueroa JE, Hull A. Atypical mycobacterial vertebral osteomyelitis: case report and review. Clin Infect Dis. 1998;26:503–5.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Wong NM, Sun LK, Lau PY. Spinal infection caused by Mycobacterium avium complex in a patient with no acquired immune deficiency syndrome: a case report. J Orthop Surg. 2008;16:359–63.

    CAS  Google Scholar 

  10. 10.

    Yamamoto K, Nabeshima T, Yonekura M, Komenobu K. Two cases of nontuberculous mycobacterial spondylitis. Central Jpn J Orthop Surg Traumatol. 1999;42:1169–70 (in Japanese).

    Google Scholar 

  11. 11.

    Wada M, Ohtubo Y, Ito D, Shibata N. A case of spondylitis due to atypical mycobacterium. Orthop Surg Traumatol. 1999;48:824–8 (in Japanese).

    Google Scholar 

  12. 12.

    Nishiguchi M. A case of spondylitis due to atypical mycobacterium. Central Jpn J Orthop Surg Traumatol. 2001;44:1125–6 (in Japanese).

    Google Scholar 

  13. 13.

    Chan ED, Kong PM, Fennelly K, Dwyer AP, Iseman MD. Vertebral osteomyelitis due to infection with nontuberculous Mycobacterium species after blunt trauma to the back: 3 examples of the principle of locus minoris resistentiae. Clin Infect Dis. 2001;32:1506–10.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Matsunaga A, Mori K, Koizumi F, Fujiwara Y, Takeuchi R, Shimakawa T, et al. Infectious spondylitis due to nontuberculous mycobacterium. J Western Jpn Res Soc Spine. 2003;29:104–6 (in Japanese).

    Google Scholar 

  15. 15.

    Ota Y, Okutani T, Tanaka M. Four cases of vertebral osteomyelitis due to non-tuberculous mycobacteria. J Western Jpn Res Soc Spine. 2008;34:98–104 (in Japanese).

    Google Scholar 

  16. 16.

    Izeki M, Ise K. Treatment of spondylodiscitis due to rare non-tuberculous mycobacteria species which was not identified by DNA–DNA hybridization (Ddh) kit and classification using genomic sequencing. Jpn Soc Study Bone Joint Infect. 2010;24:91–6 (in Japanese).

    Google Scholar 

  17. 17.

    Minematsu A, Sawai T, Matsutake T, Soejima Y, Naito S, Kohno S. A case of Mycobacterium intracellulare pulmonary infection with vertebral osteomyelitis. J Jpn Assoc Infect Dis. 2011;85:527–31.

    Google Scholar 

  18. 18.

    Petitjean G, Fluckiger U, Scharen S, Laifer G. Vertebral osteomyelitis caused by non-tuberculous mycobacteria. Clin Microbiol Infect. 2004;10:951–3.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Ingram CW, Tanner DC, Durack DT, Kernodle GW, Corey GR. Disseminated infection with rapidly growing mycobacteria. Clin Infect Dis. 1993;16:463–71.

    PubMed  Article  CAS  Google Scholar 

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We thank Katsumi Chiba and Atsuo Hamada for providing patient information, microbiological analysis, and suggestions regarding this study. We are indebted to Dr. Clifford A. Kolba (Ed.D., D.O., M.P.H.) and Associate Professor Edward F. Barroga (D.V.M., Ph.D.) of the Department of International Medical Communications of Tokyo Medical University for their editorial review of the English manuscript.

Conflict of interest

The authors have no conflicts of interest to declare associated with this study.

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Correspondence to Hiroyuki Shimizu.

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Shimizu, H., Mizuno, Y., Nakamura, I. et al. Vertebral osteomyelitis caused by non-tuberculous mycobacteria: case reports and review. J Infect Chemother 19, 972–977 (2013).

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  • Atypical mycobacteria
  • Non-tuberculous mycobacteria
  • Osteomyelitis