Atypical staphylococcus aureus infection and screws loosening mimicking recurrence of spinal tuberculosis after surgery of debridement, interbody fusion and internal fixation

Spinal tuberculosis, also named as Pott’s disease, was first described by Percival Pott in 1779. Early diagnosis and anti-tuberculosis treatment is important for spinal tuberculosis but it is really not easy to make a diagnosis of spinal tuberculosis in some atypical patients. A 14-year-old male patient presented to our hospital in July 2013 and was diagnosed as spinal tuberculosis. He received a standard anti-tuberculosis treatment after an anterior-posterior union approach surgery with instrument. However, 24 months after surgery the patient presented to our hospital again for the “recurrent” symptoms. Radiological examinations showed the screws loosening. The blood biochemical results were as follows: ESR 27.0 mm/h, C-RP 9.86 mg/L, WBC 7.42×109/L, NEUT% 60.9%. We considered this as the recurrent tuberculosis and a surgery of removal of instruments was performed. To our surprise, pathological tissue around the screws HE staining supported a pyogenic infection and the acid fast staining returned a negative result. Microbial cultivation repeatedly supported a staphylococcus aureus infection. Dressing change and intravenous levofloxacin was performed every day. After a two-week intensive therapy, the patient’ symptoms were relived and the ESR, C-RP and WBC returned to normal level. After a follow-up of 12 months, the patient was free of any discomfort, the the ESR, C-RP and WBC were all in normal level. Spinal surgeons should make a careful differential diagnosis from pyogenic spondylitis, brucellar spondylitis, sarcoidosis, metastasis, multiple myeloma, lymphoma, and other diseases before they make a diagnosis of spinal tuberculosis even in a patient with a history of spinal tuberculosis and the “recurrent” symptoms.