Stenotrophomonas maltophilia spondylodiscitis following lumbar microdiscectomy mimicking a cotton granuloma: A case report and literature review
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, Delhi, India.
DOI:10.25259/SNI_23_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nitin Maruti Adsul, Vishnu Panigrahi, Shankar Acharya, K. L. Kalra, R. S. Chahal. Stenotrophomonas maltophilia spondylodiscitis following lumbar microdiscectomy mimicking a cotton granuloma: A case report and literature review. 25-Feb-2020;11:28
How to cite this URL: Nitin Maruti Adsul, Vishnu Panigrahi, Shankar Acharya, K. L. Kalra, R. S. Chahal. Stenotrophomonas maltophilia spondylodiscitis following lumbar microdiscectomy mimicking a cotton granuloma: A case report and literature review. 25-Feb-2020;11:28. Available from: https://surgicalneurologyint.com/surgicalint-articles/9876/
Background:Vertebral osteomyelitis caused by Stenotrophomonas maltophilia is very rare. There are only two cases reported in literature. Here, we present a 48-year-old immunocompetent male who, following a lumbar microdiscectomy, developed postoperative spondylodiscitis due to S. maltophilia that mimicked a cotton granuloma.
Case Report:Two months ago, a 48-year-old male underwent a lumbar L4-L5 microdiscectomy, he newly presented with the left thigh and leg pain of 4 weeks duration. Laboratory studies revealed a CRP of 26 mg/l, an ESR of 6 mm (1st h), and total leukocyte count of 7.85 thousand/ul. The MRI T2 images showed a focal hyperintense lesion in the left lateral recesses at the L4-L5 level; the accompanying hypointense-smooth margin resembled a cotton granuloma. At surgery, we found a localized epidural collection of pus; S. maltophilia was isolated from the culture. His symptoms gradually improved, and symptoms fully resolved with 3 months of subsequent antibiotic therapy.
Conclusion:S. maltophilia causing vertebral osteomyelitis is extremely rare and can sometimes mimic a cotton granuloma. MR diagnosis, surgical decompression, and obtaining cultures are requisite to direct appropriate antibiotic therapy.
Keywords: Cotton granuloma, Spondylodiscitis, Stenotrophomonas maltophilia
Different spinal infections include spondylodiscitis, septic discitis, spondylitis, and/or vertebral osteomyelitis (e.g., including endplate and/or epidural abscess). However, vertebral osteomyelitis caused by S. maltophilia attributed to a lumbar microdiscectomy is very rare.[
Two months ago, a nonimmunocompromised hypertensive 48-year-old male underwent an L4-L5 microdiscectomy [
Laboratory studies showed a CRP of 26 mg/l, an ESR of 6 mm (1st h), and total leukocyte count of 7.85 thousand/ul. MRI T2 images showed a focal hyperintense lesion in the left lateral recesses at the L4-L5 level with an accompanying hypointense/smooth margin resembling a cotton granuloma [
S. maltophilia is a Gram-negative aerobic bacillus that is commonly found in the environment causing hospital- acquired infections in immunocompromised hosts. It is typically resistant to most broad-spectrum antibiotics.[
Laboratory evaluations for S. maltophilia infections typically show elevated WBC counts (60%), elevated ESR and CRP levels (90%), and positive blood cultures (65%).[
A high degree of suspicion was required in this case to diagnose S. maltophilia as causing postoperative spondylodiscitis and must be differentiated from cotton granulomas. Here, after obtaining definitive cultures utilizing open surgical approach, prolonged antibiotics treatment was warranted.
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