Histologic and Laboratory Findings -- Bilateral Back Pain and Fever

HISTOLOGIC AND LABORATORY FINDINGS:

Histologic examination of debrided vertebral material showed granulation tissue with necrosis, and severe acute and chronic osteomyelitis with osteonecrosis (Images 02, 03, 04). Gram and Grocott stains showed scattered and clustered branching filamentous organisms, which varied from long slender forms to short coccobacilli, often producing chains (Images 05, 06). Drainage fluid culture showed numerous neutrophils, occasional macrophages, and numerous gram-positive branching filamentous organisms (Image 07). Microbiological workup showed that the organism was catalase negative, nonmotile, and glucose fermentation positive (see Table 1). The isolated organism was sensitive to penicillin, ciprofloxacin, ampicillin, and resistant to vancomycin (see Table 2).

    Table 1. -- Culture Results

Strict aerobe	Bata-hemolysis	catalase	motility	H2S/TSI	Ecculin	glucose	mannitol	salicin
Negative	Negative	Negative	Negative	Negative	Negative	Positive	Negative	Negative


    Table 2. -- Sensitivity

Antibiotics	Minimum Inhibitory Concentration (MIC) micro gram/ml
Ampicillin	less than 1.0 (Sensitive)
Ciprofloxacin	less than or equal to 0.06 (Sensitive)
Penicillin	less than 0.5 (Sensitive)
Rifampin	less than or equal to 0.5 (Sensitive)
Tetracycline	less than or equal to 0.25 (Sensitive)
Vancomycin	greater than 16 (Resistant)