2009 Southern Regional Meeting Abstracts

Purpose of Study: Eikenella corrodens is a small, fastidious, capnophilic, anaerobic gram-negative rod found in gingival and bowel flora of approximately 40-70% of people. It is most often implicated in infections secondary to human bites. E. corrodens also causes endocarditis, head and neck infections, and periodontitis. There have been multiple case reports of osteomyelitis caused by E. corrodens, several involving penetrating injury and subsequent contamination with oral flora. However, few cases of E. corrodens have been in children, and only one has been vertebral osteomyelitis or diskitis.
Methods Used: Literature review
Summary of Results: A healthy 17-year-old girl presented to our hospital with worsening of subacute back pain of 2 months duration. There was no history of trauma, fever, or sudden onset of symptoms. MRI of the spine and Bone Scan suggested vertebral osteomyelitis. Inflammatory markers were not significantly elevated {ESR 30 (nl 0-20), CRP <3 (nl 0-10)}. She was treated with clindamycin and subsequently switched to vancomycin secondary to lack of clinical improvement. With the hope of establishing a definitive diagnosis, an open biopsy was done. Pathology revealed acute and chronic inflammation and granulation tissue formation consistent with osteomyelitis and associated diskitis. Gram stain of bone tissue revealed tiny gram negative rods and cultures grew E. corrodens after which ampicillin was started. She completed 8 weeks of IV ampicillin and required extensive physical therapy. She had a slow recovery unrelated to continued infection, but rather to physical injury.
Conclusions: The first and only reported case of E. corrodens infective diskitis in the pediatric population was also in an adolescent without any evidence of trauma and a prolonged history of back pain.
Vertebral osteomyelitis and diskitis in the pediatric population is mostly seen in younger children and common implicated pathogens are S. aureus, Streptococci, H. influenzae, and Enterobacter species. Consideration must be taken to include E. corrodens as a possible pathogen for this type of infection, especially in adolescents with a less acute course. It should also be considered in patients without clinical improvement on conventional antibiotic therapy as E. corrodens is resistant to clindamycin.