Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 5, Number 2, February 2014, pages 108-112

Penicillin-Resistant Streptococcus Pneumoniae Meningitis With Subsequent Vertebral Osteomyelitis and Choledocholithiasis

Figures

Figure 1.
Figure 1. Magnetic resonance imaging (MRI) of lumbar vertebrae and abdominal CT scan in patient 1. Vertebral osteomyelitis and choledocholithiasis with gall stones. A: T1-weighted image (FA 150 TR 600 TE 12) of the lumbar vertebrae shows regions of low intensity in the L4 vertebral body and L3-4 and L4-5 intervertebral discs. B: Fat-suppression T2-weighted image (FA 150 TR 4000 TE 96) of the lumbar vertebrae shows regions of high intensity in the L3, L4, and L5 vertebral bodies and L3-4, L4-5 intervertebral discs. C: No gallstones or choledocholithiasis on admission. D: A stone in the lower portion of the common bile duct (arrow) and small stones in the gall bladder (arrowhead) on the 77th hospital day.
Figure 2.
Figure 2. MRI of lumbar vertebrae and abdominal CT scan in patient 2. Vertebral osteomyelitis and choledocholithiasis with gall stones. A: T1-weighted image (FA 150 TR 600 TE 12) shows regions of low intensity in the L4 and L5 vertebral bodies and L4-5 intervertebral disc. B: T2-weighted image (FA 150 TR 4000 TE 96) shows regions of high intensity in the L4 and L5 vertebral bodies and L4-5 intervertebral disc. C: No gallstones or choledocholithiasis on admission. D: A stone in the lower portion of the common bile duct (arrow) on the 50th hospital day.

Table

Table 1. Characteristics of Patients With Meningitis and Vertebral Osteomyelitis
 
AuthorAge/ sexBacteriaGall stoneCholedocholithiasisCharacteristics
SA: Staphylococcus aureus; N/A: not available; PRSP: penicillin resistant Streptococcus pneumoniae; PSSP: penicillin sensitive Streptococcus pneumoniae; S: Streptococcus
Markus et al Case 1 [6] Case 260/M 46/FSA SAN/A (-)N/A (-)A psoas abscess
Chemlal et al [2]52/MPRSP(-)(-)
Turner et al patient 8 [10]79/FPSSPN/AN/AEndocarditis
Poyanli et al [8]51/FPSSP(-)(-)Psoas abscesses
Brouwer et al Case 1 [5] Case 251/M 39/FPSSP PSSPN/A N/AN/A N/A
Fukushima et al [6]62/MGroup B SN/AN/AEpidural abscess
Tsutsumi et al [9]62/MGroup B S(-)(-)Rectal ulcer Paraspinal muscle abscess
Patient 165/MPRSP(+)(+)Endocarditis
Patient 257/MPRSP(+)(+)