Abstract
Background: Acute low back pain is one of the most common reasons for adults to see a physician. However, vertebral osteomyelitis (VO) is a rare condition, which mostly affects the lumbar spine. Lumbar spine MRI imaging is the diagnostic method of choice. If left untreated can lead to vertebral destruction or spinal abscess formation. Case: An 86-year-old man presented with a stroke to our facility, while undergoing therapy complained of excruciating low back pain that prevented him from undergoing therapy specially standing and walking. His vital signs were normal, and he was afebrile. Plain X-ray of the lower spine showed osteoarthritic changes. Patient was initially started on non-steroidal anti-inflammatory (NSAID) with no change in the severity of his low back pain. Lumbar vertebral spine magnetic resonance imaging (MRI) showed lumbar vertebral osteomyelitis. Initiation of IV antibiotics dramatically decreased the pain severity. Conclusion: Low back pain is common in the elderly population and responds effectively to NSAID. Persistence of low back pain in the presence of pathognomonic changes in the lumbar spine MRI indicate the presence of VO. Prompt treatment with empirical antibiotics is warranted.
Highlights
Vertebral osteomyelitis (VO) is a rare condition with an incidence 2/100,000 individuals/year, [1, 2] common in men, over 60 years of age [2, 3]
If left untreated it can lead to spinal cord compression from either vertebral destruction or spinal abscess and even death [4, 5]
Prompt treatment with IV antibiotics is needed as delay risks joint and bone destruction, and cord compression and death from septicemia
Summary
Vertebral osteomyelitis (VO) is a rare condition with an incidence 2/100,000 individuals/year, [1, 2] common in men, over 60 years of age [2, 3]. An 86-year-old man with a history of hypertension and osteoarthritic joints pain presents to our facility with a sudden onset of left facial droop and left-sided weakness On neurological evaluation he had a left facial and left arm and leg weakness in keeping with a right sided acute stroke, which was confirmed by head MRI. Repeat medical and neurological examination was unchanged from admission including being afebrile throughout this time He was initially started on non-steroidal antiinflammatory medication and later changed to opiate analgesic which offered partial pain relief [7,8,9]. Figure 2a: Sagittal lumbar spine MRI T1 image without gadolinium showing bony hyperintensity in keeping with osteomyelitis (black *). Figure 2b: Axial lumbar spine MRI T1 image without gadolinium showing bony hyperintensity in keeping with osteomyelitis (white *)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
