Tuberculous Spondylitis and Salmonella Mycotic Aneurysm in an Immunocompromised Patient: A Case Report

Abstract

Despite the proximity of the vertebral bodies and discs to the vascular structures of the retroperitoneum, the association of spinal osteomyelitis and aortic infection is a rare1, easily overlooked, but potentially lethal condition that requires prompt diagnosis and aggressive surgical therapy. The pathogens responsible for concurrent vertebral and aortic lesions include Salmonella species as well as other gram-negative bacilli, mycobacteria, gram-positive cocci, and fungi1-3. A delay in the start of appropriate antimicrobial therapy for infections involving these anatomic sites could result in bone and joint destruction and possibly death. We report the case of an elderly immunocompromised patient who had a mycotic aneurysm caused by Salmonella species. After aneurysmectomy, he experienced persistent back pain and progressive loss of lower-extremity neurological function. Further work up disclosed tuberculous lumbar spondylitis and an epidural abscess in the vicinity of the resected aneurysm. The case of this patient emphasizes the possibility of coexistent infection in vulnerable patients. The pitfalls in diagnosis and management are discussed, to enable clinicians to avoid potentially catastrophic complications. The patient was informed that data concerning the case would be submitted for publication. A seventy-nine-year-old man presented to our emergency service because of fever and chills that he had had for eight days. The history included the use of analgesics and a steroid (20 mg/day of prednisolone) for one year for the treatment of chronic low back pain. On arrival, the patient was febrile (38.4°C), with a blood pressure of 150/90 mm Hg. Physical examination revealed a cushingoid habitus (moon face, truncal obesity, and paper-thin skin), a pulsatile abdominal mass, and low back pain limiting his spinal flexibility. Plain radiographs of the lumbar spine showed multiple traction spurs along the anterior edges of the vertebrae and decreased disc height at L3-L4 without overt evidence …