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Non-tuberculous mycobacterial thoracic osteomyelitis in an immunocompetent host: a rare presentation of Mycobacterium kansasii
  1. Taylor Becker1,
  2. Matthew Smith2,
  3. Meredith Parsons3 and
  4. Michihiko Goto2
  1. 1Department of Internal Medicine, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Department of Infectious Diseases, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3Department of Pathology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Taylor Becker; taylor-becker{at}


An immunocompetent man in his 40s presented with 3 months of mid-thoracic back pain which progressed to include progressive paraesthesias and lower extremity weakness. Investigations revealed thoracic spine osteomyelitis with signs of cord compression. He underwent neurosurgical intervention, including laminectomy, spinal cord decompression and partial resection of an epidural mass. Initial intraoperative biopsy and surgical pathology results were concerning for an acid-fast bacillus as the causative pathogen, and the patient was given empiric therapy for presumed Mycobacterium tuberculosis. However, microbiology speciation revealed the presence of the non-tuberculous mycobacterium (NTM) Mycobacterium kansasii, which resulted in an alteration of his antimicrobial therapy. This case highlights the importance of considering NTM as a possible aetiology of spinal osteomyelitis, even among immunocompetent individuals or in low-prevalence regions.

  • Bone and joint infections
  • TB and other respiratory infections

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  • Contributors MS and MG identified this patient as a valuable case report. TB performed the literature review and wrote initial drafts of the manuscript under the expert guidance of all other authors. MP performed the pathological evaluation of surgical specimens and provided microbiological expertise. All authors were involved in the drafting, editing, formatting and final approval of this case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.