Infectious spondylodiscitis. A diagnostic challenge. Case report

Abstract

BACKGROUND: Infectious spondylodiscitis or vertebral osteomyelitis is rare, involves colonization of the disc’s space and the adjacent vertebral bodies. CLINICAL CASE: Male patient 59 years old diabetic and hypertensive long evolution is hospitalized in September 2015 with diagnosis of Wagner III diabetic foot. In April 2016 he was readmitted presenting gramnegasystemic inflammatory response syndrome consistent with fever of unknown origin, acute liver and renal failure, being diagnosed bilateral psoas’ abscess and chronic cholecystitis by abdominal tomography, coursing at the eight day with acute chronic calculous cholecystitis, performing exploratory laparotomy with cholecystectomy because of piocolecisto discovery, psoas’ abscess was not found, treated with triple antibiotic scheme achieving contain sepsis and renal and hepatic function was reestablished, medical discharge, persisting with lumbar bone pain, which is exacerbated with mobilization and ambulation, accompanied by fever spike. Follow-up visit with important disabling pain. Lumbosacral spine MRI showed spondylodiscitis at the level of L2-L3 with paravertebral collection. He was rehospitalized for 8 days for antibiotic management, with favorable evolution, continuing management with oral antibiotics for a period of 8 months. CONCLUSION: Infectious spondylodiscitis is rare and difficult diagnose, but whenever a fever of unknown origin is present should take into account.