Case Report

Vertebral Osteomyelitis Caused by Prevotella (Bacteroides) Melaninogenicus

Authors: Surabhi Mukhopadhyay, MD, Fredrick Rose, MD, Vincent Frechette, MD

Abstract

A 35-year-old, previously healthy female presented with severe low back pain, fever, and a high erythrocyte sedimentation rate 1 week after a routine dental cleaning. Technetium-labeled leukocyte scanning and magnetic resonance imaging scan of the spine were negative for osteomyelitis. The patient underwent biopsy, cultures from which grew Prevotella (Bacteroides) melaninogenicus. Appropriate antibiotic therapy resulted in resolution of symptoms. P melaninogenicus is a Gram-negative anaerobic bacillus that is part of the indigenous oral flora. It may cause dental, sinus, skin, and soft tissue infections. Infection of bone is rare. Only three cases of vertebral osteomyelitis due to P melaninogenicus have been reported in the literature. The early diagnosis of vertebral osteomyelitis requires a high index of clinical suspicion and cannot be excluded by negative imaging tests alone. The recovery of this unusual organism highlights the importance of requesting anaerobic cultures of biopsy specimens.


Key Points


* Negative imaging studies cannot rule out early vertebral osteomyelitis.


* Anaerobes should be considered in the pathology of vertebral osteomyelitis, and all specimens should be sent for anaerobic cultures.


* Prevotella (Bacteroides) melaninogenicus can, rarely, cause vertebral osteomyelitis.

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