Infective Spondylodiscitis of Unknown Origin in a Patient with Chronic Kidney Disease – Case report

Abstract

Introduction: Infective spondylodiscitis, resulting from bacterial or fungal infections in intervertebral discs and adjacent vertebral bodies, poses diagnostic dilemmas due to its rare occurrence and subtle symptomatology. This report underscores the importance of a multidisciplinary approach in navigating the complexities of infective spondylodiscitis, particularly in patients with concomitant chronic kidney disease (CKD). Case Report: A 53-year-old male, 5 years into renal dialysis for CKD, presented with a 3-month history of severe neck pain radiating to both arms, accompanied by tingling sensations. Neurological evaluation revealed weakness and gait imbalance. Laboratory findings indicated elevated serum creatinine, erythrocyte sedimentation rate, and C-reactive protein. Imaging confirmed vertebral destruction, necessitating a staged treatment plan involving surgical intervention, corpectomy, mesh placement, and fusion. Intraoperative cultures yielded negative results, prompting continued broad-spectrum antibiotic therapy intravenously for 2 weeks, followed by an additional 4 weeks orally. Discussion: The case discussion explores common risk factors for infective spondylodiscitis, emphasizing the need for a comprehensive diagnostic approach in patients with immunocompromised conditions, such as CKD. Despite negative cultures, the patient's favorable clinical response and neurological recovery underscore the intricate nature of infectious processes, especially in individuals with underlying health concerns. Conclusion: This case report serves as a poignant reminder of the challenges associated with infective spondylodiscitis in CKD patients on hemodialysis. The classic triad of pain, fever, and neurological deficits should trigger a thorough diagnostic investigation, leveraging advanced imaging techniques for accurate diagnosis. A multidisciplinary approach and regular follow-ups are essential in managing such complex cases, contributing to improved patient outcomes and overall healthcare quality. Keywords: Infective spondylodiscitis, chronic kidney disease, unknown origin, hemodialysis, corpectomy, anterior cervical discectomy with fusion, fusion.