Successful surgical intervention for acute pyothorax caused by methicillin-resistant Staphylococcus aureus thoracic pyogenic spondylitis: a case report

Background: Pyogenic spondylitis or intervertebral discitis rarely spreads into the thoracic cavity, resulting in pyothorax. Moreover, no study has reported methicillin-resistant Staphylococcus aureus (MRSA) as a cause. Conservative and surgical treatments are reportedly effective for the above-mentioned situations; however, there have been no comprehensive reports owing to the disease's rarity. This report described a case of acute pyothorax due to MRSA-caused pyogenic spondylitis in which surgical intervention with curettage of the intrapleural abscess and simultaneous thoracic vertebral debridement and anterior fixation were effective.

Case presentation: A 60-year-old female with Parkinson's disease was diagnosed with pyogenic spondylitis caused by MRSA and managed with antibiotics. Subsequently, a right encapsulated pleural effusion was observed, and thoracentesis was performed. No bacteria were identified in the pleural fluid culture; nonetheless, the leukocytes in the fluid increased, and the patient was diagnosed with right acute pyothorax caused by pyogenic spondylitis. Management of the spondylitis and pyothorax before the disease became severe was necessary. We performed curettage of the intrapleural abscess and vertebral debridement and anterior fixation using an autogenous rib through open thoracotomy. The inflammation or accompanying symptoms did not worsen 3 months after hospital discharge.

Conclusions: Acute pyothorax is rare but may develop from pyogenic spondylitis, for which MRSA is a rarer causative agent. Simultaneous vertebral debridement and anterior fixation, with curettage of the thoracic cavity abscess, may be useful in its management.