A rare case of invasive non-typeable Haemophilus influenzae spondylodiscitis and periprosthetic joint infection

Abstract

A non-typeable Haemophilus influenzae (NTHi) was responsible for an invasive infection including bacteremia, spondylodiscitis with epidural abscess, and periprosthetic hip infection in a 79-year-old woman, triggered by a superinfected ethmo-orbital mucocele. Surgical drainage and antibiotic therapy allowed recovery. PET-scan full cartography of NTHi infection dissemination enabled the discovery of spondylodiscitis. This rare cause of spondylodiscitis and periprosthetic joint infection suggests a complete work-up is unavoidable.

Figure 1

Non-typeable Haemophilus influenzae invasive spondylodiscitis started from a bacteremia of the ENT entry site and shows an unreported mechanism of dissemination. (a) PET scan; other images show a continuous fixation along the iliopsoas muscle; (b, c) spine and pelvic T1-weighted gadolinium-enhanced MRI: ${}^{*}$ L4–L5 spondylodiscitis with epidural abscess; $\mathit{\#}$ right medial iliopsoas infiltration; ¶ hip prosthesis infection. (d) Sinus T2-weighted MRI and (e) peri-operative view of endo-nasal surgery after opening the right ethmo-orbital mucocele: ÷ mucocele revealed a clear mucoid content that underwent Haemophilus influenzae-specific PCR, positive for a non-typeable strain. (a), (b), (c), and (d) are courtesy of the Radiology Department of Gustave Dron Hospital.