[Harrison]

I thought I posted these a while back, but I guess not! Here are some more interesting cases.
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Infectious spondylitis [Article in Spanish]
Pintado-García V.
Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España.

Vertebral osteomyelitis or spondylodiscitis is an uncommon, mainly hematogenous, disease that usually affects adults. The incidence of this condition has steadily risen in recent years because of increases in spine surgery and nosocomial bacteremia, aging of the population, and intravenous drug addiction. Pyogenic infection due to Staphylococcus aureus is the most frequent form of the disease, but tuberculosis and brucellosis are still common causes of spondylitis in Spain.

The clinical presentation is nonspecific and the diagnosis is often delayed. Magnetic resonance imaging is the most sensitive radiologic technique for this disease. Blood cultures are often positive, but computed tomography-guided needle biopsy or surgical biopsy of the affected vertebra is sometimes required to achieve a microbiological diagnosis. Prolonged antibiotic therapy and occasionally surgery are essential for cure in most patients, and both factors have contributed to a reduction in the morbidity and mortality of the disease in recent years.

Spondylodiscitis and infectious endocarditis: a round-trip to be considered.
Calderaro D, Gualandro DM, Yu PC, Marques AC, Puig LB, Caramelli B.
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil.

The association between spondylodiscitis and endocarditis was first reported in 1965 by de Sèze et al. The most common clinical picture of this association is musculoskeletal symptoms preceding endocarditis diagnosis, but we report here a case of spondylodiscitis complicating endocarditis in its late course.

A 70-year-old man, with an established diagnosis of mitral valve endocarditis caused by Streptococcus intermedius, early submitted to surgical treatment because of heart failure, who had an uneventful recovery up to the 12th day of antibiotic therapy when he presented intensive backache, with tenderness in the two lower lumbar vertebras. Spondylodiscitis was confirmed by a magnetic resonance imaging and the treatment was non-esteroidal anti-inflammatory and analgetics drug, with good results, and prolongation of antibiotic treatment up to 3 months. Appropriate diagnosis of this association has important consequences, as the …..

Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess.
Metta H, Corti M, Brunzini R.
Unit 17, Division B, Infectious Diseases, FJ Muñiz Hospital and Santa Lucia Hospital, Buenos Aires, Argentina.

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment.

We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.