Streptococcus constellatus vertebral osteomyelitis

1. Interesting case Mar 23 rd , 2011

10. Graphic data

11. Graphic data

12. Graphic data

13. Graphic data

14. Graphic data

15. EKG

16. CBC 9/2/11 12/2/11 21/2/11 26/2/11 7/3/11 21/3/11 Hb 12.4 12.5 11.3 11 11 10.4 Hct 36.7 36.5 35.1 32.3 34.8 33.1 WBC 16,250 13,870 13,200 10,560 9,640 6,910 PMN 96 86 86 86 77 70 Lym 2 7 7 6 7 7 Platelet 443,000 476,000 569,000 453,000 448,000 385,000

17. MRI lumbosacral spine (10/2/11) Discitis-spondylolitis at L2 and L3 A 2.5cm anterior epidural abscess

18. MRI lumbosacral spine (10/2/11) A 6cm Rt psoas abscess

19. MRI lumbosacral spine (10/2/11) Microabscesses with phlegmon in the paravertebral soft tissue

27. CXR (12/2/11)

28. LS spine (12/2/11) Narrowing disc spaces of L3-4, L5-S1 and spondylosis with mild lumbar scoliosis.

29. LS spine (1/3/11) Compression fracture L2

30. MRI lumbosacral spine (4/3/11)

32. LS spine (7/3/11)

33. LS spine (14/3/11)

34. LS spine (21/3/11)

35. 28/2/11 7/3/11 14/3/11 21/3/11 ESR (0-28 mm/hr) 94 92 61 68 CRP (< 5 mg/L) 108 53 45 49

37. Vertebral osteomyelitis

45. Werner Zimmerli, M.D. Basel University Medical Clinical Liestal Kantonsspital Liestal, Switzerland. N Engl J Med 2010; 363:1022-9