Spondylodiscitis due to Stenotrophomonas maltophilia after endoscopic spine surgery: a case report
Abstract
Abstract Background. Infection after endoscopic spine surgery is rare, but without timely diagnosis and treatment it can cause severe vertebral destruction. Stenotrophomonas maltophilia is an intrinsically multidrug-resistant, non-fermenting gram-negative bacillus and an exceptionally rare cause of spinal infection. Case presentation. We report a 54-year-old immunocompetent woman who underwent interlaminar endoscopic discectomy for a right L4–L5 disc herniation. Mechanical low back pain began on postoperative day 3 without fever. Magnetic resonance imaging (MRI) on day 52 demonstrated L4–L5 spondylodiscitis. A positive interferon-gamma release assay (IGRA) led to a presumptive diagnosis of spinal tuberculosis treated with a 2RHZE/10RHE regimen, followed by empirical meropenem plus vancomycin; both failed. By day 87, imaging showed osteolysis of the inferior endplate of L4, and the Spinal Instability Spondylodiscitis Score (SISS) was 7, indicating potential instability. The patient underwent posterior L2–S1 instrumentation with L4–L5 debridement. Intraoperative cultures grew S. maltophilia , whereas tuberculosis polymerase chain reaction (PCR) and culture were negative. She received combination levofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) for six weeks. At 18 months she was pain-free with stable imaging, and the instrumentation was removed. Conclusions. To our knowledge, this is the first reported case of S. maltophilia spondylodiscitis after endoscopic spine…
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