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Vertebral Osteomyelitis Complicated by Pneumococcal Pneumonia Cured by Early Oral Antimicrobial Therapy
1)Department of Respiratory Medicine, Itabashi Chuo Medical Ceter, 2)Department of Respiratory Medicine, Tokyo Metropolitan Police Hospital, 3)Department of Respiratory Medicine, NTT Medical Center Tokyo
Yusuke OHNARI1)2), Tomohiro HAYASHI1), Kouhei WATANABE1), Yuri TANIGUCHI1)3), Chinami NAGASAWA1), Yu ENOMOTO1), Hiroshi IGEI1), Jun SHIKAMA1), Takao HANEHIRA1) & Tadashi TAKAO1)
(Received October 25, 2017)
(Accepted March 27, 2018)
Key words: pneumococcal disease, vertebral osteomyelitis, oral antibiotic therapy

A previously healthy 74-year-old male presented with anorexia, fever, wet cough, and altered consciousness. He was admitted to Itabashi Chuo Medical Center and diagnosed as having pneumococcal pneumonia complicated by sepsis and bacterial meningitis. His symptoms initially improved with antibiotic and anticoagulant therapy. However, the fever reappeared and a new symptom of lumbago surfaced after, he had completed the full course of treatment. Magnetic resonance imaging of the lumbar spine revealed a high-intensity lesion between L4 and L5, indicating a diagnosis of pyogenic spondylitis. Blood cultures indicated that Streptococcus pneumoniae had in fact caused the spondylosis. After seven days, the patient requested a switch from intravenous to oral antibiotic treatment, and this improved the symptoms of fever and lumbago. Symptoms did not recur after a six-week course of oral antibiotics. Symptoms of spondylitis are important to consider in patients with pneumococcal pneumonia, and short-term intravenous antibiotic treatment with follow-up oral therapy for pneumococcal pyogenic spondylitis may enable early discharge.

[ Kansenshogaku Zasshi 92: 542-546, 2018 ]

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