Eikenella Corrodens Vertebral Osteomyelitis

A 53-year-old man returned from a trip to Thailand and reported a 3-week history of severe nocturnal back pain and low-grade fevers. A magnetic resonance imaging (MRI) study performed within 1 week of the onset of symptoms showed a contrast-enhancing lesion consistent with hemangioma in the T11 vertebral body. A three-phase radionuclide bone study obtained 4 weeks later revealed intense vascularity and delayed uptake in T10 and T11, consistent with osteomyelitis. A computed tomographic (CT) scan subsequently showed bony destruction of T11 with a paraspinal soft tissue mass. Cultures of the paraspinal fluid grew Eikenella corrodens and a secondary growth of coagulase-negative Staphylococcus. E. corrodens is a small, fastidious, gram-negative anaerobic bacillus that is a normal oropharyngeal resident. The most common presentations of infection are hand abscesses after fist fights and osteomyelitis of the mandible, related to poor dental hygiene. Osteomyelitis elsewhere is rare, and the time to make a correct diagnosis is frequently prolonged. It has been reported previously in the spine of an otherwise healthy middle-aged man. The authors hypothesize that infection in the current patient may have been precipitated by transient bacteremia, with seeding of the vertebral hemangioma and subsequent infection of surrounding bone.