Sterile spondylodiscitis

Abstract

In April, 2011, an 85-year-old man was referred to our hospital with suspected septic spondylodiscitis; he had acute immobilising back pain, raised body temperature, and high C-reactive protein (CRP) concentration. His medical history included chronic back pain because of advanced spinal degeneration, chronic renal insufficiency, and gouty arthritis. On physical examination, his lumbar spine and right flank were very tender. The distal interphalangeal joint of the right index finger was painful, warm, and swollen. He was clinically stable. Blood tests showed the following raised values: white blood cell count 25·3×109/L (without a left shift of the neutrophils), CRP 349 mg/L, creatinine 162 μmol/L, and uric acid 513 μmol/L. MRI of the lumbar spine was consistent with spondylodiscitis at L1–L2, and showed an abscess-like formation in the right psoas muscle (figure).