Destructive Cutibacterium (formerly Propionibacterium) avidum cervical osteomyelitis

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A 77-year-old obese man with diabetes mellitus presented cervical stiffness and mechanical pain, fatigue and 8 kg weight loss lasting for 3 months. Two months before presentation, malaria in Cameroon had been treated with intra-muscular quinine injections complicated by Streptococcus pneumoniae gluteal abscess requiring surgical drainage and amoxicillin. The patient was afebrile with weakness of neck extension and pain on mobilization. CRP was 68 mg/l. Blood cultures were negative. Cervical MRI (Fig. 1A and B) and CT scan (Fig. 1C) displayed destructive cervical osteomyelitis. Two disco-vertebral biopsies grew Gram-positive bacilli belonging to genus Cutibacterium, identified as C. avidum. Treatment consisted of a 6-week course of oral amoxicillin/rifampin, and C4–C5 corpectomy with anterior cervical plating and iliac crest grafting. Clinical response was excellent at 3 months, with bony fusion on CT scan (Fig. 1D). Imaging of destructive Cutibacterium avidum cervical osteomyelitis (A) T1-weighted contrast-enhanced cervical MRI, sagittal plane, showing diffuse hypersignal of the C4 and C5 vertebral bodies and disk. (B) T2-weighted cervical MRI, sagittal plane, showing hypersignal of the C4 and C5 vertebral bodies and disk with a deformity resulting in kyphosis. (C) Cervical scanner, median sagittal plane, demonstrating pathological fractures and subluxation of C4–C5, with a cervical kyphosis of 25°. (D) Cervical scanner, median sagittal plane, showing 3-months postoperative correction of kyphosis following C4–C5 corpectomy with anterior plating and iliac crest graft with early signs of bony fusion. Imaging of destructive Cutibacterium avidum cervical osteomyelitis (A) T1-weighted contrast-enhanced cervical MRI, sagittal plane, showing diffuse hypersignal of the C4 and C5 vertebral bodies and disk. (B) T2-weighted cervical MRI, sagittal plane, showing hypersignal of the C4 and C5 vertebral bodies and disk with a deformity resulting in kyphosis. (C) Cervical scanner, median sagittal plane, demonstrating pathological fractures and subluxation of C4–C5, with a cervical kyphosis of 25°. (D) Cervical scanner, median sagittal plane, showing 3-months postoperative correction of kyphosis following C4–C5 corpectomy with anterior plating and iliac crest graft with early signs of bony fusion. Cutibacterium avidum is part of the normal flora of the skin and sebaceous glands, with low pathogenicity [1]. Rarely, it is responsible for slow-developing, locally destructive post-surgical infections in the hip, shoulder and breast regions [1, 2]. Direct inoculation or contiguous spread is the main mechanism of the disease, often in obese patients, from moist breast or groin skin folds. In our patient, haematogenic dissemination leading to cervical osteomyelitis was likely. Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript. Disclosure statement: The authors have declared no conflicts of interest.

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