A Case of Pyogenic Spondylodiscitis Caused by Campylobacter fetus for Which Early Diagnosis by Magnetic Resonance Imaging Was Difficult
A 37-year-old male who engages in construction work (manual labor) with unremarkable medical history presented at his nearby hospital with fever (≥39℃, <40℃) that had no specific trigger nine days before the presentation. The results of a blood test were a white blood cell (WBC) count of 18,900/mm3 (<9,000/mm3) and C-reactive protein (CRP) of 0.62 mg/dl (<0.1 mg/l). He was prescribed non-steroidal anti-inflammatory drugs and oral antibiotics; however, the fever persisted and low back pain had appeared four days before the visit. Body movement became difficult, and he was hospitalized in his nearby hospital. No obvious abnormal finding was observed on lumbar MRI (); however, infection was suspected, and intravenous infusion of cefotiam was started. Low back pain and fever did not improve and lumbar MRI was repeated on the twenty-sixth day after onset (). MRI revealed abnormal signals at vertebrae and disc spaces, and blood culture at the time of hospitalization detected C. fetus. Pyogenic spondylitis was diagnosed, and the patient was moved to the internal medicine department of our hospital. Gadolinium enhancement MRI was performed by the request of our internist, and the result strongly suggested pyogenic spondylitis.\nHe underwent combination therapy of broad spectrum antibiotics; however, the inflammatory reaction did not mitigate after six weeks. To clarify if other causative organisms were involved in the inflammation, computed tomography (CT)-guided biopsy was performed after four days' cessation of antibiotics. Biopsy revealed negative results for tuberculosis, atypical mycobacterium, eumycetes, and cultivation of bacteria. He was transferred to our orthopaedic department at 8 weeks, and C. fetus was speculated to be the causative organism (). He was treated with intravenous infusion of cefotaxime, ciprofloxacin, and minocycline, and rested with a brace. At 13 weeks after the start of treatment, WBC was in the normal range. At 14 weeks, CRP was negative (), low back pain was improved, and MRI showed reduction of the lesion; thus, the treatment was changed to oral ciprofloxacin and minocycline and the patient discharged. He received outpatient antibiotics, choosing one or two drugs out of ciprofloxacin, minocycline, and erythromycin for 11 months. CRP temporally became negative after 14 weeks of onset, then CRP increased and became negative repeatedly. Finally, CRP was completely negative after 15 months of onset. Lesions had almost disappeared on MRI after one year, and the vertebral body showed high signal intensities on both T1- and T2-weighted images (). Activities of daily living were permitted without restriction after the discharge. Light work and general work was permitted after 6 and 9 months, respectively. After 13 months, back pain had almost disappeared and he performed hard labor without problems.