Spondylodiscitis Associated with Multiple Vascular Accesses for Hemodialysis

Abstract

Introduction: Spondylodiscitis (also called vertebral osteomyelitis) is the most frequent form of bone involvement. The most frequently isolated pathogen is S. aureus (more than 50% of cases), which can lead to disabilities and even death [4]. The most common pathogenic route is hematogenous dissemination, favored by the irrigation system of the spinal column, mainly affecting the lumbar spine due to its greater vascularization [5]. Case Report: A 67-year-old female with a history of stage 5 chronic kidney disease secondary to nephroangiosclerosis due to arterial hypertension, on renal replacement therapy 13 years ago, initially with peritoneal dialysis for approximately 11 years, with subsequent admission to three-weekly hemodialysis 2 years ago. Presents sudden mild to moderate low back pain, increasing progressively for 2 weeks, becoming incapacitating; presented painful lumbar region with active movements; flexoextension of the lower limbs limited by pain, right lower limb: positive straight leg raise (SLR) test and Lasègue’s sign. A magnetic resonance of the spine showed signs of spondylodiscitis between L4/L5 vertebrae, conditioning spinal canal stenosis; disc protrusion between L3-L4 and L4-L5 vertebrae; a probable abscess in the left multifidus muscles and a fluid collection in the right iliac muscle. Conclusions: Early identification of high-risk patients could improve patients’ safety and care. Implementation of diagnostic scores should be evaluated in centers with high flow of hemodialysis patients. Pain relief should be assessed appropriately and warranted for patients who overcome spondylodiscitis to improve their quality of life. Adequate treatment, initialized by prompt intravenous broad-spectrum antibiotic administration should be given to diminish morbidity and mortality.