PNEUMOCOCCAL VERTEBRAL OSTEOMYELITIS

Vertebral osteomyelitis is an unusual complication of pneumococcal inf ection. This report describes a patient who presented with back pain a nd lower extremity weakness after bacteremic pneumococcal pneumonia. M agnetic resonance imaging showed destruction of the L-4-L-5 vertebral bodies and thecal sac compression, and Streptococcus pneumoniae was is olated from an aspirate of the disk space. We found only 10 other case s of pneumococcal vertebral osteomyelitis in a review of the literatur e. In these 11 cases the presentations were usually subacute, and the onset of back pain was insidious. Elevated erythrocyte sedimentation r ates were commonly noted, Computed tomography and magnetic resonance i maging were most helpful in delineating the extent of involvement in p atients seen in the last decade. Successful treatment included surgery alone in 2 cases that occurred before the antibiotic era, surgery plu s 6 weeks of antibiotic therapy in 1, and antibiotics alone for 4 week s to 7 months in 5. Two patients seen in the preantibiotic era died.