Disseminated Septic Emboli, Septic Thrombosis of the Vena Cava and the Common Iliac and Renal Veins, and Retroperitoneal Abscess Secondary to Pyogenic Spondylitis of the Lumbar Spine

Abstract

Pyogenic spondylitis is an infection of the spine that can include the disc, bone, the epidural space, and adjacent structures1,2. With adequate clinical suspicion and appropriate diagnostic evaluation, most pyogenic spine infections can be managed with culture-specific antibiotics2,3. However, in certain cases, surgery may be necessary to perform an open biopsy or treat a clinically relevant abscess, spinal instability, a severe deformity, or a neurologic deficit; surgery may also be necessary because of the failure of nonoperative treatment1-3. Septic thrombosis of the vena cava is a rare disease entity that causes substantial morbidity and mortality from septicemia and septic emboli4. Most commonly, septic thrombosis of the vena cava occurs as a complication of prolonged central venous catheterization4,5. Other, uncommon causes include inflammatory processes that extend to the wall of the vena cava6-9. We present here a case of pyogenic spondylitis and disseminated septicemia with septic thrombosis of the vena cava, the common iliac vein, and the renal vein. The patient was informed that the data concerning this case would be submitted for publication. A fifty-six-year-old woman was transferred to our emergency department with a sudden onset of sepsis, with dyspnea, a stuporous mentality, and weakness of both lower extremities. She had been generally in a good state of health until two weeks previously, when she developed lower back pain. She underwent nonoperative treatment for lower back pain during those previous two weeks, and she was given antibiotic treatment (ceftriaxone) for a fever that suddenly developed two days before arrival in our emergency room. She had had diabetes mellitus and high blood pressure for many years. She had no history of intravenous drug or alcohol abuse. There was no …