Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient
Journal
Spinal Cord
Journal Volume
49
Journal Issue
9
Pages
1020-1022
Date Issued
2011
Author(s)
Abstract
Study design:Case report.Objective:Vertebral osteomyelitis, usually presented with back pain and local tenderness, can pose a great challenge of early diagnosis among spinal cord injury (SCI) patients who lost sensation below the injured level. We reported a paraplegic patient who had recurrent febrile episodes after being treated as urinary tract infection initially and was discovered later to have vertebral osteomyelitis.Case report:A 41-year-old man, completely paralyzed at the T11 level and with Foley catheterization for 9 years, was re-admitted within 2 weeks for recurrent fever, turbid urine, bacteriuria and bacteremia with Escherichia coli. Spine X-ray and renal, cardiac and abdominal ultrasonography showed no definite lesions related to infection in a previous admission. Intermittently febrile episodes continued despite treatment with antibiotics for 1 week. He had no pressure sores or other wounds. Computerized tomography and magnetic resonance imaging showed lumbosacral osteomyelitis and bilateral paravertebral abscess. The patient underwent debridement of paravertebral tissue. Fever subsided soon after surgery and the patient continued antibiotics and remained free of fever at a 1-year follow-up.Conclusion:It can be challenging to diagnose vertebral osteomyelitis below injury levels in SCI patients. Vertebral osteomyelitis should be considered in febrile SCI patients even with known infectious foci, as classic symptoms of osteomyelitis are lacking in this population. ? 2011 International Spinal Cord Society. All rights reserved.
SDGs
Other Subjects
ceftibuten; ceftriaxone; cefuroxime; ciprofloxacin; adult; anamnesis; antibiotic therapy; article; bacterium culture; bacteriuria; biopsy; case report; clinical feature; computer assisted tomography; contrast enhancement; debridement; delayed diagnosis; echography; Escherichia coli; follow up; human; intervertebral disk degeneration; intervertebral diskectomy; male; nonhuman; nuclear magnetic resonance imaging; paraplegia; paravertebral abscess; priority journal; psoas abscess; spinal cord injury; spine disease; spine radiography; spondylitis; treatment duration; treatment response; urinary tract infection; urine culture; Adult; Delayed Diagnosis; Escherichia coli Infections; Humans; Lumbar Vertebrae; Male; Osteomyelitis; Paraplegia; Sacrum; Urinary Tract Infections
Type
journal article