Article Text

Download PDFPDF
Enterobacter cloacae as sole organism responsible for vertebral osteomyelitis/discitis and vertebral collapse in a patient with intravenous drug abuse
  1. Su Khine1,
  2. Lara Rabah1,
  3. Nageshwari Palanisamy1,
  4. Kailin Liroff2 and
  5. Ghassan Bachuwa1
  1. 1Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
  2. 2Infectious Disease Department, Hurley Medical Center, Flint, Michigan, USA
  1. Correspondence to Dr Ghassan Bachuwa; gbachuw2{at}


Staphylococcus aureus is the most commonly isolated organism in osteomyelitis, while gram-negative bacteria (GNB) comprises only a minor portion. GNB osteomyelitis is usually seen in patients with bacteraemia, recent genitourinary infection, open fractures or trauma and is rarely seen in the spines. Our case is a man in his 30s with no significant risk factors except an extended history of intravenous drug use (IVDU), who presented with back pain and subsequently developed vertebral collapse. Bone culture grew Enterobacter cloacae, yet blood cultures were negative. To date, there are limited data on the prevalence of GNB osteomyelitis in IVDU and its association. Due to rising rates of IVDU, further research must be done into associated medical complications to provide comprehensive care. Moreover, the emergence of multidrug-resistant GNB strains limits the number of effective antibiotics and is expected to pose more serious public concerns in the future.

  • Infections
  • Bone and joint infections
  • Back pain

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—SK, LR, NP, KL and GB. NP took the initiative to write the report, and collected patient data and consent. SK and LR drafted the initial manuscript. SK, LR and NP contributed to the revision of literature review and discussion under the supervision of KL. All authors are involved in proofreading. SK formatted the case report and added images/tables according to BMJ guidelines. GB supervised the whole submission process and provided suggestions to the report. The following authors gave final approval of the manuscript—SK, LR, NP, KL and GB.

  • 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.