Artropatía vertebral de Charcot en lesionados medulares: problema diagnóstico

Abstract

Neuropathic osteoarthropathy, or Charcot joint disease, was first described in 1868 in patients affected by tabes dorsalis, and it is currently a recognized entity among the sequelae of chronic spinal cord lesions. However, its diagnosis and treatment are still under discussion, and various publications make reference to the difficulties of differential diagnosis in cases of osteoarthropathies of infectious origin affecting the spine. The diagnosis is complex in patients with spinal cord lesions that have symptoms and signs of infection, and the two processes can even overlap. We describe two cases of patients with long-standing spinal cord lesions that presented findings compatible with neuropathic spinal articulations but that gave rise to a problem in the differential diagnosis with infectious arthritis. A surgical approach enabled histological and microbiological studies, confirming Charcot's disease and ruling out infection of the intervertebral space in the second case. Conclusion In patients presenting febrile syndromes of unknown origin and a generally declining state of health whose laboratory findings indicate infection, the differential diagnosis can be hindered when it is difficult to differentiate Charcot's disease from pyogenic discitis or Pott's disease on imaging studies. The possibility of superinfection of a Charcot joint must be taken into account, and the surgical approach is usually necessary.