Chronic enterococcal spinal implant infection 6 years after instrumentation of a severe scoliosis in a 22-year-old woman

A 22-year-old woman with severe double curve scoliosis was instrumented in 2006 (posterior instrumentation T2-L5). In 2007–2008, the patient had progressive worsening of the scoliosis. In August 2012, she presented with mild oozing matter from the surgery scar in the middle of her back (figure 1A)....

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Bibliographic Details
Published in:BMJ case reports 2015-06, Vol.2015, p.bcr2015209782
Main Authors: Virot, Emilie, Barrey, Cédric, Chidiac, Christian, Ferry, Tristan
Format: Article
Language:English
Subjects:
Amoxicillin - administration & dosage
Amoxicillin - therapeutic use
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - therapeutic use
Bacteriology
Enterococcus faecalis - isolation & purification
Female
Gram-Positive Bacterial Infections - drug therapy
Gram-Positive Bacterial Infections - etiology
Gram-Positive Bacterial Infections - microbiology
Humans
Images In
Immunology
Life Sciences
Microbiology and Parasitology
Postoperative Complications - microbiology
Prosthesis-Related Infections - microbiology
Scoliosis - microbiology
Scoliosis - surgery
Spinal Fusion - adverse effects
Spinal Fusion - instrumentation
Virology
Young Adult
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Summary:A 22-year-old woman with severe double curve scoliosis was instrumented in 2006 (posterior instrumentation T2-L5). In 2007–2008, the patient had progressive worsening of the scoliosis. In August 2012, she presented with mild oozing matter from the surgery scar in the middle of her back (figure 1A). There was no pain. Her C reactive protein level was 1 mg/L in plasma. There was no reason to consider other sites of infection. Spinal X-rays showed failure of surgery for correction of sagittal imbalance with worsening of the spinal deformity, implant migration and implant loosening at the lower part of the instrumentation (figure 1B). Late postoperative spinal implant infection with fistula was diagnosed. Total explantation of the instrumentation (including the 2 rods and the hooks) with wide debridement was performed, and abscesses, detected close to each hook, were drained. Surgical samples grew Enterococcus faecalis. The patient received high doses of intravenous amoxicillin for 1 month and amoxicillin orally for 4 months thereafter. No pain remained and the spinal deformity has not worsened at 2-year follow-up.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2015-209782