Case Report

Atypical Pott's Disease: Localized Infection of the Thoracic Spine due to Mycobacterium avium-intracellulare in a Patient without Human Immunodeficiency Virus Infection

Authors: Jay B. Mehta, MD, Mark W. Emery, MD, Mirle Girish, MD, Ryland P. Byrd, Jr., MD, Thomas M. Roy, MD

Abstract

Mycobacterium avium-intracellulare (MAI) rarely causes disease of the spine in healthy individuals. We describe an elderly woman who had isolated skeletal involvement with MAI, mimicking Pott's disease. She responded well to surgical excision of the inflamed tissue and antibiotic therapy. Osteomyelitis due to MAI must be differentiated from that due to Mycobacterium tuberculosis because the treatment regimens are different.

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References

1. Mehta JB, Dutt AK, Harvill L, Mathews KM. Epidemiology of extrapulmonary tuberculosis: A comparative analysis with pre-AIDS era. Chest 1991; 99: 1134–1138.
2. Nightingale SD, Byrd LT, Southern PM, Jockusch JD, Cal SX, Wynne BA. Incidence of Mycobacterium avium-intracellular complex in human immunodeficiency virus-positive patients. J Infect Dis 1992; 165: 1082–1085.
3. Falkinham JO. Epidemiology of infection by nontuberculous mycobacteria. Clin Microbiol Rev 1996; 9: 177–215.
4. O'Brien RJ, Geiter LJ, Snider DE. The epidemiology of nontuberculous mycobacteria diseases in the United States: Results from a national survey. Am Rev Respir Dis 1987; 135: 1007–1014.
5. American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med 1997; 156( Suppl 2): S1–S25.
6. Bennett SN, Peterson DE, Johnson DR, Hall WN, Robinson-Dunn B, Dietrich S. Bronchoscopy-associated Mycobacterium xenopi pseudoinfections. Am J Respir Crit Care Med 1994; 150: 245–250.
7. Hellinger WC, Smilack JD, Greider JL Jr, Alvarez S, Trigg SD, Brewer NS, et al. Localized soft tissue infections with Mycobacterium avium/Mycobacterium intracellular complex in immunocompetent patients: Granulomatous tenosynovitis of the hand or wrist. Clin Infect Dis 1995; 21: 65–69.
8. Wallace RJ Jr, Musser JM, Hull SI, Silcox VA, Steele LC, Forrester GD, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis 1989; 159: 708–716.
9. Desplaces N, Picardeau M, Dinh V, Leonard PH, Mamoudy P, Raguin G, et al. Spinal infections due to Mycobacterium xenopi after discectomies. Presented at the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA, 1995 (Abstract J162).
10. Zvetina JR, Demos TC, Rubinstein H. Mycobacterium intracellulare infection of the shoulder and spine in a patient with steroid-treated systemic lupus erythematous. Skeletal Radiol 1982; 8: 111–113.
11. Pirofsky JG, Huange CT, Waites KB. Spinal osteomyelitis due to Mycobacterium avium-intracellulare in an elderly man with steroid-induced osteoporosis. Spine 1993; 18: 1926–1932.
12. Pombo D, Woods ML II, Burgert SJ, Shumsky IB, Reimer LG. Disseminated Mycobacterium avium complex infection presenting as osteomyelitis in a normal host. Scand J Infect Dis 1998; 30: 622–623.
13. Brodkin H. Paraspinous abscess with Mycobacterium avium-intracellulare in a patient without AIDS. South Med J 1991; 84: 1385–1386.
14. Chan ED, Kong P, Fennelly K, Dwyer AP, Iseman MD. Vertebral osteomyelitis due to infection with nontuberculous Mycobacterium species after blunt trauma to the back: Three examples of the principle of locus minoris resistentiae. Clin Infect Dis 2001; 32: 1506–1509.
15. Weiner BK, Love TW, Fraser RD. Mycobacterium avium-intracellulare: Vertebral osteomyelitis. J Spinal Disord 1998; 11: 89–91.
16. Horsburgh CR. Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med 1991; 324: 1332–1338.
17. Dutt AK, Stead VW. Long-term results of medical treatment in Mycobacterium intracellulare infection. Am J Med 1979; 67: 449–453.
18. Davidson PT, Khanijo V, Goble M, Moulding TS. Treatment of disease due to Mycobacterium intracellulare. Rev Infect Dis 1981; 3: 1052–1059.
19. Holland SM, Eisenstein EM, Kuhns DB, Turner ML, Fleisher TA, Strober W, et al. Treatment of refractory disseminated nontuberculous mycobacterial infection with interferon γ: A preliminary report. N Engl J Med 1994; 330: 1348–1355.
20. Arend SM, Janssen R, Gosen JJ, Waanders H, de Boer T, Ottenhoff TH, et al. Multifocal osteomyelitis caused by nontuberculous mycobacteria in patients with a genetic defect of the interferon-γ receptor. Neth J Med 2001; 59: 140–151.

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