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KMID : 0829320140170030099
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Korean Journal of Clinical Microbiology
2014 Volume.17 No. 3 p.99 ~ p.103
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A Case of Pyogenic Spondylitis Due to Aggregatibacter aphrophilus
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Kim Kye-Hyung
Kim Nam-Hee
Shin Kyung-Hwa
Kim Shin-Young
Chang Chul-Hun L.
Yi Jong-Youn
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Abstract
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Aggregatibacter aphrophilus, a normal component of oral cavity flora, mostly causes infective endocarditis and only rarely causes spondylitis; no spondylitis cases have been previously reported in Korea. We report a case of pyogenic spondylitis due to A. aphrophilus without endocarditis. A 64-year-old man was admitted for back pain lasting 3 weeks. There was severe tenderness on lumbar spines but no fever. Laboratory evaluation showed leukocytosis and elevated C-reactive protein. Blood cultures were negative. Magnetic resonance imaging showed psoas abscess and vertebral inflammation. Pus was obtained by computerized tomography-guided aspiration from the psoas abscess and inoculated into blood culture bottles. After 5 days of incubation, growth was detected: the isolate was a Gram-negative short rod bacteria identified as A. aphrophilus by the automated system; this was confirmed by 16S ribosomal RNA sequencing. There was no evidence of endocarditis in echocardiography and retinal examination. Back pain persisted despite 8 weeks of antibiotic treatment, so vertebral corpectomy was performed. A. aphrophilus, a rare cause of pyogenic spondylitis, can induce spondylitis without endocarditis. If a patient with pyogenic spondylitis shows negative routine bacterial cultures, fastidious organisms such as A. aphrophilus should be suspected and the blood culture bottles could be used.
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KEYWORD
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Aggregatibacter aphrophilus, Pyogenic spondylitis, Vertebral osteomyelitis
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