Advanced Magnetic Resonance Imaging in the Evaluation of a Chronic Non-healing ulcer - A Case Report of Rare Primary Cutaneous Leiomyosarcoma.

INTRODUCTION

Anaerobic vertebral osteomyelitis has been reported rarely. In this report, we describe an extremely rare case of a patient who suffered from vertebral osteomyelitis caused by Peptostreptococcus micros.

CASE REPORT: A 73-year-old man with a history of diabetes mellitus was admitted to our hospital with a 5-month history of severe low back pain. A radiograph of the lumbar spine demonstrated intervertebral disc space narrowing with indistinct end plates at the L3-L4 level. T2-weighted magnetic resonance image showed high signal intensity at L3-L4 intervertebral disc space. We suspected pyogenic spondylitis and performed percutaneous posterolateral endoscopic debridement. The results of intraoperative sample cultures were positive for P. micros, an anaerobic Gram-positive coccus. He was treated by the antibiotic therapy. Low back pain resolved and his white blood cell count and C-reactive protein levels remained normal with the combination therapy. During 2-year follow-up, he reported no low back pain and had no signs of infection recurrence.

CONCLUSION

If a patient who was in immunodepression status develops severe back pain, the clinician should be suspicious of the possibility of spondylitis by P. micros and start antibiotic therapy after undergoing sample collection.