The Brief Case: Uncommon pathogen, unusual presentation— Ureaplasma urealyticum in a post-laminectomy infection
Year: 2026
Type: article
Study design: Case Report
Abstract: A 75-year-old man with no relevant medical history was admitted after developing acute left ankle pain following a period of prolonged immobility.After multiple courses of nonsteroidal anti-inflammatory drugs with no significant clinical improve ment, multilevel spinal canal stenosis was diagnosed.In April 2025, the patient underwent decompressive laminectomy at various levels.In the postoperative period, the patient developed two episodes of acute urinary retention, both of which required bladder catheterization.Seven days after the second episode, the patient developed hematuria.Although urine sediment analysis showed no evidence of urinary tract infection, the drainage bag was replaced, and empirical antibiotic therapy with cefixime 200 mg every 12 h was initiated for 5 days.No cultures were obtained during this episode.Early postoperative follow-up revealed a fluctuant subcutaneous swelling adjacent to the surgical wound incision without inflammatory signs.Three weeks later, erythema and localized warmth developed, and computed tomography demonstrated deep and superficial fluid collections.In view of these findings, urgent surgical exploration with wound revision and surgical debridement was performed.Intraoperatively, macerated and devitalized tissue with a characteristic "cooked" and friable appearance was identified.Liquid samples from the deep and superficial surgical area were processed, and Gram-stained smears (performed using a standard technique with safranin as counterstain) revealed no microorganisms.Furthermore, no growth was observed in conventional culture media (blood, chocolate, and brucella agar) or in enriched brain heart infusion broth for the detection of aerobic and anaerobic bacteria.All of them remained negative after 7 days of incubation at 37°C.Empirical antimicrobial therapy was initiated with extended-infu sion cefepime 2 g q8h and daptomycin 850 mg q12h.One month after surgery, magnetic resonance imaging (MRI) showed persistent fluid collections with minimal radiological improvement, prompting escalation to meropenem 2 g q8h and vancomycin 1 g q12h.During the 3 weeks following surgical debridement, no leukocytosis or procalcitonin elevation was observed.C-reactive protein (CRP) was mildly elevated (7.21-10.1 mg/dL) (normal range, 0.06-0.5 mg/dL), and the patient experienced intermittent low-grade fever with persistently negative blood cultures.Interventional radiology performed additional drainage, and two newer liquid samples were submitted.Gram staining showed no microorganisms in either specimen, although polymorphonuclear leukocytes were present in the purulent deep sample.Both specimens were processed for culture as previously described, and no microbial growth was observed after 7 days of incubation at 37°C.
Source: Journal of Clinical Microbiology
DOI: 10.1128/jcm.01857-25
Language: English
Subfield: Microbiology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W7221796718