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Case Reports   |    
Tuberculous Spondylitis and Salmonella Mycotic Aneurysm in an Immunocompromised PatientA Case Report
Shih-Hao Chen, MD1; To Wong, MD1; Fang-Ying Kuo, MD1; Chen-Hsiang Lee, MD1
1 Departments of Orthopaedic Surgery (S.-H.C. and T.W.) and Pathology (F.-Y.K.) and Division of Infectious Diseases (C.-H.L.), Chang Gung Memorial Hospital, No.123, Ta Pei Road 833, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. E-mail address for C.-H. Lee: lee900@adm.cgmh.org.tw
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Departments of Orthopaedic Surgery and Pathology and the Division of Infectious Diseases, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University of Medicine, Kaohsiung, Taiwan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Oct 01;88(10):2275-2278. doi: 10.2106/JBJS.E.01121
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Extract

Despite the proximity of the vertebral bodies and discs to the vascular structures of the retroperitoneum, the association of spinal osteomyelitis and aortic infection is a rare1, easily overlooked, but potentially lethal condition that requires prompt diagnosis and aggressive surgical therapy. The pathogens responsible for concurrent vertebral and aortic lesions include Salmonella species as well as other gram-negative bacilli, mycobacteria, gram-positive cocci, and fungi1-3. A delay in the start of appropriate antimicrobial therapy for infections involving these anatomic sites could result in bone and joint destruction and possibly death. We report the case of an elderly immunocompromised patient who had a mycotic aneurysm caused by Salmonella species. After aneurysmectomy, he experienced persistent back pain and progressive loss of lower-extremity neurological function. Further work up disclosed tuberculous lumbar spondylitis and an epidural abscess in the vicinity of the resected aneurysm. The case of this patient emphasizes the possibility of coexistent infection in vulnerable patients. The pitfalls in diagnosis and management are discussed, to enable clinicians to avoid potentially catastrophic complications. The patient was informed that data concerning the case would be submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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