Enterobacter agglomerans Spondylodiscitis: A Possible, Unrecognized Complication of Tetracycline Therapy

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Study Design.This case report describes infection in a lumbar disc in a healthy young man with an organism of low pathogenicity. The patient was taking a prolonged course of antibiotics at the time the infection occurred.Objective.To describe this unique case of infective spondylodiscitis.Summary of Background Data.To the authors’ knowledge, spinal infection with Enterobacter agglomerans has never been reported. This organism is a transient gut colonizer, and may have established itself secondary to the patient’s prolonged ingestion of tetracycline for acne.Methods.This 22-year-old farmer had spontaneous lumbar back pain. Radiologic investigations showed an abnormality in the L4–L5 disc region, and together with other investigations, were suggestive of infection. The diagnosis was confirmed by surgical aspiration.Results.Antibiotic therapy was administered, and the patient made a complete recovery. Follow-up radiographs showed a complete loss of the L4–L5 disc space with only minimal bone destruction.Conclusion.A unique cause of infective lumbar discitis is presented. Several features of this case are unusual. The magnetic resonance findings were not readily diagnostic. The cultured organism is usually nonpathogenic. The infection may have been secondary to prolonged tetracycline therapy.

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