Hematogenous Dissemination Research Articles

Abstract IA009: Biology and vulnerabilities of circulating tumor cell clusters

Abstract The metastatic spread of cancer occurs through the generation and hematogenous dissemination of circulating tumor cells (CTCs). Among these, CTC clusters have recently emerged as key players in the metastatic process. With a combination of microfluidic technologies and single cell-resolution molecular analysis applied to cancer patients and mouse models, we gained fundamental insights into the biology, vulnerabilities, and clinical implications of CTC clusters. For instance, we found that their physical features enable molecular changes that promote stemness and metastasis, allowing us to define new treatment concepts aimed at suppressing their metastatic potential. Further, we investigated CTC heterogeneity at the single cell level, revealing fundamental interactions that occur between CTCs and immune cells and that accelerate metastasis formation, as well as microenvironment signals that impact on CTC generation. More recently, we also gained important insights into CTC generation dynamics and signals that trigger intravasation. Together, our findings support a model whereby upon defined microenvironmental cues, CTCs form multicellular aggregates to expand their metastatic ability, providing a new rationale for targeting these interactions in cancer. Citation Format: Nicola Aceto. Biology and vulnerabilities of circulating tumor cell clusters [abstract]. In: Proceedings of the AACR Special Conference: Cancer Metastasis; 2022 Nov 14-17; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_2):Abstract nr IA009.

A 3D multi-cellular tissue model of the human omentum to study the formation of ovarian cancer metastasis

Reliable and predictive experimental models are urgently needed to study metastatic mechanisms of ovarian cancer cells in the omentum. Although models for ovarian cancer cell adhesion and invasion were previously investigated, the lack of certain omental cell types, which influence the metastatic behavior of cancer cells, limits the application of these tissue models. Here, we describe a 3D multi-cellular human omentum tissue model, which considers the spatial arrangement of five omental cell types. Reproducible tissue models were fabricated combining permeable cell culture inserts and bioprinting technology to mimic metastatic processes of immortalized and patient-derived ovarian cancer cells. The implementation of an endothelial barrier further allowed studying the interaction between cancer and endothelial cells during hematogenous dissemination and the impact of chemotherapeutic drugs. This proof-of-concept study may serve as a platform for patient-specific investigations in personalized oncology in the future.

Blastomycosis: A Review of Mycological and Clinical Aspects.

Blastomycosis is caused by a thermally dimorphic fungus that thrives in moist acidic soil. Blastomyces dermatitidis is the species responsible for most infections in North America and is especially common in areas around the Great Lakes, the St. Lawrence Seaway, and in several south-central and southeastern United States. Other Blastomyces species have more recently been discovered to cause disease in distinct geographic regions around the world. Infection almost always occurs following inhalation of conidia produced in the mold phase. Acute pulmonary infection ranges from asymptomatic to typical community-acquired pneumonia; more chronic forms of pulmonary infection can present as mass-like lesions or cavitary pneumonia. Infrequently, pulmonary infection can progress to acute respiratory distress syndrome that is associated with a high mortality rate. After initial pulmonary infection, hematogenous dissemination of the yeast form of Blastomyces is common. Most often this is manifested by cutaneous lesions, but osteoarticular, genitourinary, and central nervous system (CNS) involvement also occurs. The diagnosis of blastomycosis can be made by growth of the mold phase of Blastomyces spp. in culture or by histopathological identification of the distinctive features of the yeast form in tissues. Detection of cell wall antigens of Blastomyces in urine or serum provides a rapid method for a probable diagnosis of blastomycosis, but cross-reactivity with other endemic mycoses commonly occurs. Treatment of severe pulmonary or disseminated blastomycosis and CNS blastomycosis initially is with a lipid formulation of amphotericin B. After improvement, therapy can be changed to an oral azole, almost always itraconazole. With mild to moderate pulmonary or disseminated blastomycosis, oral itraconazole treatment is recommended.

Subdural empyema secondary to contralateral sinusitis: hematogenous dissemination?

Sinusitis refers to inflammation in the sinuses. Complications of sinusitis are rare and most often affect the orbit. However, in rare cases, these complications may be intracranial. One of these intracranial complications is subdural empyema, which is a loculated suppuration between the dura mater and the arachnoid. Despite its rarity, it has a high mortality rate and is often underestimated by physicians. We report here a rare case of a 5-year-old girl with a subdural empyema secondary to contralateral sinusitis. She was admitted to a local hospital complaining of fever, nasal congestion and headache for 6 days. Antibiotic therapy was initiated on admission. After six days, the patient maintained the previous symptoms and developed a decreased level of consciousness, a right hemiparesis and had a witnessed tonic-clonic seizure. This prompt her transfer to a tertiary hospital for brain computed tomography (CT) scan, which revealed a left subdural collection and a right maxillo-sphenoid sinusitis. She was referred to neurosurgical care and underwent surgical drainage of the empyema. There were another two complications of sinusitis: periorbital cellulitis and frontal osteomyelitis (both on the right). The patient was discharged from the tertiary hospital on day 39 without neurological sequelae. This case shows a rare complication of sinusitis and its clinical, surgical and radiological features and reinforces to physicians the importance of being aware of the possible complications of sinusitis. The peculiarity of the case is attributable to the way in which bacterial spread from sinusitis to a contralateral subdural empyema occurred.

CASES' DIAGNOSED WITH SPONDYLODISCITIS DURING THE YEARS 2010–2020. DIAGNOSIS, TREATMENT AND COMPLICATIONS

Abstract Introduction Spondylodiscitis is a rare infectious pathology with high morbidity and mortality that affects the intervertebral disc and adjacent vertebrae. It is most commonly found in the lumbar spine. It is mainly caused by haematogenous dissemination. It is a diagnostic challenge because its main manifestation, low back pain, is a prevalent symptom in the population. Methods A retrospective study of patients diagnosed with spondylodiscitis between 2010–2020 (n=60) was carried out. Exclusion criteria (n=14): follow-up less than one year, previous spinal surgery, first year mortality. Measurements made in plain radiology. Statistical analysis STATA 15.2. Statistical significance p<0,05. Results Average age: 68.17 years, 55% were males, 45% were females. Risk factors analyzed: 26.09% of the patients had diabetes, 8.70% kidney disease, 6.52% rheumatism, 6.52% were PVDA; about smoking 10.87% were smokers, 17.39% ex-smokers and the 71.74% were non-smokers; 8.70% had prescriptions of immunosuppressants and 19.57% had cancer before or during this episode. 50% had previous infection (n=23); 34.78% had urinary infection, 13.04% had knee prosthesis, 8.69% had respiratory infection, endocarditis the 30.43%, 17.36% had another sort of infection. The average delay to diagnosis was 40.36 days (SD 37.68). Total duration of antibiotic therapy, including days of hospital stay and those which were ambulatory: 134 days (SD 129.96); duration of hospitalization: 43 days. Surgical treatment was performed in 15.56% of the patients. a spacer was the technique used in the 14.29% of the patients; although the fixation was used in the 71.42% of the patients, the majority was a posterior fixation with the 57.14%, the anterior fixation was only used in the 14.29%. The acute complications found in this study were in this order, abscess with nearly half of the patients (n=22), phlegmon (n=3), vertebral destruction (n=2) and meningitis (n=1). No differences were obtained in the angle of kyphosis after pathology (p. 052), no increase in complications due to surgery (p=0.62), no difference in the cure of patients with targeted treatment (p=0.57), nor with surgical treatment (p=0.95), nor in the percentage of cure with diagnostic delay (p=0.76). Conclusions Spondylodiscitis is a pathology with non-specific symptoms, which leads to diagnostic delay. The cure rate with medical treatment is high, but it is essential to identify the causal germ in order to initiate targeted antibiotherapy and avoid the appearance of complications and long-term sequelae.

Diagnostic Dilemma in a Rare Jaw Metastasis: A Case Report

Malignant tumors that have metastasized to the oral and maxillofacial region from distant sites account for only 1% of all malignancies of the jaw. These metastasize most often to the mandibular molar region. The commonest primary sources of metastatic tumors found in the oral and maxillofacial region are the lung, kidney and prostate gland for the males, and the breast, genital organs and kidneys for females. Uterine cervix cancer is the second most common female cancer and the third most common cause of female cancer mortality. The tumor spreads into the surrounding tissues by direct infiltration, but hematogenous dissemination is relatively unusual and the involvement of oral and maxillofacial region is extremely rare in gynecological cancer. Here a case of a 45-year-old woman is presented, who had a lesion of sunburst type appearance radiographically and poorly differentiated squamous cell carcinoma histologically involving the maxillofacial region, which metastasized from uterus cervix.

Uloga radioterapije u lečenju Ewing sarkoma kostiju

Ewing sarcoma (ES) is the second most common primary bone malignancy after osteosarcoma. The disease most often occurs in adolescence, with peak incidence around the age of fourteen. The most common primary location of the tumor is the bones of the pelvis, followed by the ribs, spine and long bones of the extremities such as the tibia and the fibula. ES shows a tendency towards hematogenous dissemination, primarily in the lungs and bones, much less often lymphogenously. One third of patients have distant metastases present at initial diagnosis, which is why ES is considered a systemic disease. The treatment of Ewing sarcoma is based on a multimodal approach that includes the use of chemotherapy, surgery and/or radiotherapy. The identification of prognostic parameters enabled the individual treatment of patients based on the assessed risk group. With the application of modern therapeutic protocols, five-year survival for patients with localized disease lies between 60% and 68%, while for patients with metastatic disease, five-year survival is still unsatisfactory and is around 17%. ES belongs to the group of radiosensitive tumors, and radiotherapy plays a very important role in the local control of the disease, in combination with surgical treatment or independently, and can be applied as radical, preoperative or postoperative radiation therapy. Also, radiation therapy has a role in the palliative approach to the treatment of lung metastases and other metastatic sites. Considering that the modern multimodal treatment of Ewing sarcoma leads to long-term survival, it is necessary to take into account the expected side effects of the therapy that can reduce the quality of life of treated patients. Modern radiotherapy techniques such as three-dimensional conformal radiation therapy (3D CRT), intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) enable precise delivery of the prescribed dose of radiation to target volumes with better sparing of surrounding normal tissues and organs, which leads to a lower incidence of late sequelae of radiation therapy and enables the preservation of the quality of life of treated patients.

Pulmonary Candidiasis in an Immunocompetent Patient

Clinically, fungi infections of the respiratory system are uncommon. The pathogen culture and the clinical characteristics are frequently used in the clinical diagnosis of fungi. Two different patterns of invasive pulmonary candidiasis have been described: primary candida bronchopneumonia and secondary pulmonary disease arising from haematogenous dissemination or rarely primary bronchopneumonia. Primary candida bronchopneumonia is limited largely to immunocompromised patients and is thought to occur by aspiration of candida into the upper respiratory tract. This is a case of a 55-year-old male who presented with the chief complaint of dyspnoea on exertion, intermittent fever, and cough associated with expectoration of 1-month duration. The fever was moderate grade and intermittent without chills, rigours, or night sweats. Respiratory system examination revealed bilateral scattered course crackles in both lung fields. Chest X-ray revealed heterogeneous opacities in bilateral upper lobes and hyperinflation of the lung. Biopsy specimens from para hilar (centrilobular nodules) were obtained and stained with haematoxylin/eosin, periodic acid Schiff, and Gram stain. Clusters of pseudohyphae and budding yeasts were detected in the nodules, indicating candida infection. Sputum microscopy confirmed pulmonary candidiasis. The patient’s bronchoscopy was done and bronchoalveolar lavage was sent for investigations and the growth of candidiasis came positive.

VEGF-C Expressing Tumor-Associated Macrophages Decrease Hematogenous Metastatic Dissemination and Normalizes the Tumor Vasculature

VEGF-C Expressing Tumor-Associated Macrophages Decrease Hematogenous Metastatic Dissemination and Normalizes the Tumor Vasculature

КАРЦИНОМАТОЗ ЛЕГЕНЬ: ОСОБЛИВОСТІ КЛІНІЧНОЇ ТА РАДІОЛОГІЧНОЇ СЕМІОТИКИ

The term “carcinomatosis” characterizes multiple metastases to serous membranes or organ parenchyma, caused by malignant tumor in patient’s body. Even though the name of this secondary neoplasia is derived from the name of malignant tumor originated from epithelial tissue — “carcinoma”, the term “carcinomatosis” is used to define a wide range of advanced metastases of malignant neoplasm of any origin. The main route of metastatic spread is hematogenous, less often — lymphatic, rare — aerogenous of through the diaphragm. According to autopsy data lung metastases are frequently found in chorionepithelioma, osteogenic sarcoma, kidney, testis, breast, and prostate cancer. In early hematogenous dissemination phase clinical signs are usually mild due to preliminary subpleural localization of metastases in lung. Only when visceral pleura, chest wall or bronchi are penetrated such symptoms as cough, chest pain, hemoptysis, dyspnea, and fever appear. Lymphangitic carcinomatosis is a secondary malignancy due to dissemination of tumor cells via the lymph vessels. In most cases the lymphangitic carcinomatosis is a result of primary hematogenous spread of metastases, appearing on radiograms or computed tomography scans as densities — nodules, mases or consolidation. In about 6–8 % of cases lymphangitic carcinomatosis are characterized by dissemination of tumor exclusively into lung interstitium without a distortion of lung parenchyma. This may cause a lot of difficulties for differential diagnosis. Despite the high diagnostic efficacy of bronchoscopy, video thoracoscopy and lung histology, the leading tool at initial stage of diagnostics is a high resolution computed tomography (CT). The article presents several clinical cases of lymphangitic carcinomatosis, observed at Interstitial lung diseases department of National Institute of phthisiology and pulmonology named after F. G. Yanovsky NAMS of Ukraine. Key words: lung carcinomatosis, clinical features, differential diagnosis, computed tomography.

Эндогенный эндофтальмит на фоне аутоиммунного гепатита: клиническое наблюдение

Endogenous endophthalmitis (EE) is a severe inflammatory disease resulting from hematogenous dissemination of pathogenic agents (bacteria, fungi) from the primary focus into the choroid due to impaired permeability of blood-ocular barrier. Retina, vitreous body, and anterior chamber are further involved. This paper describes a 61-year-old woman with EE associated with autoimmune hepatitis (AIH). Ocular inflammation was preceded by bacteremia. Clinical signs of EE included vitreitis, choroidal effusion, and exudative retinal detachment followed by amaurosis and phthisis bulbi. In 2008, the woman was diagnosed with AIH of unknown origin. Insulin-dependent diabetes developed secondary to treatment with prednisolone. After canceling steroids, AIH progressed to cirrhosis. Here, the development of EE was probably associated with secondary immunodeficiency in the setting of AIH. The timely diagnosis of EE is important for selecting an effective treatment strategy that involves intravitreal antibiotics and vitrectomy. Ophthalmologists should be aware of previous fever or flu-like disorder, severe ocular inflammation (hypopion, vitreitis, choroidal effusion, retinal detachment), no red reflex, and severe vision loss. KEYWORDS: endogenous endophthalmitis, autoimmune hepatitis, vitrectomy, intravitreal injections, and phthisis bulbi, hypopyon, choroid, bacteremia, cirrhosis, retinal detachment. FOR CITATION: Belov D.F., Korotkov V.G., Nikitin P.A., Terekhova I.V., Konenkova Ya.S. Endogenous endophthalmitis associated with autoimmune hepatitis: case report. Russian Journal of Clinical Ophthalmology. 2023;23(3):164–169 (in Russ.). DOI: 10.32364/2311-7729- 2023-23-3-9.

Chromobacterium violaceum Related Urinary Tract Infection: A Case Report

Chromobacterium violaceum (C. violaceum) is a motile, gram-negative bacilli found in water and moist soil. Infections due to C. violaceum are uncommon but have a significant mortality rate (upto 80%) due to their tendency for haematogenous dissemination resulting in sepsis. The organism has been reported to cause skin and soft tissue infections, diarrhoea, bacteremia, and visceral abscess; Urinary Tract Infection (UTI) is rarely seen. Here, a 41-year-old male diabetic who presented with fever, altered sensorium and burning micturition caused by C.violaceum is presented. Initial investigations revealed an increased Random Blood Sugar (RBS) level, high anion gap metabolic acidosis with normal renal and liver function (except for hypoalbuminemia). Diabetic ketoacidosis, probable meningitis and urosepsis were considered as differential diagnosis. On culture of urine sample, C. violaceum was isolated which was susceptible to all the antibiotics tested except amikacin. Blood culture was reported as sterile. Patient was successfully treated with susceptible antibiotic (ciprofloxacin) and repeat culture of urine was also sterile. Early diagnosis and adequate treatment is necessary to reduce the risk of progression to fatal infection.

A Rare Case of Choriocarcinomatous Pulmonary Embolism revealed by Ischemic Strokes

Choriocarcinoma is a malignant tumor with high metastatic potential belonging to the spectrum of gestational trophoblastic tumors, which can be of germ cell origin (nongestational) or gestational. Choriocarcinomatous pulmonary embolism represents a rare and aggressive extra-gonadal form of gestational trophoblastic disease, most often occurring after a normal or pathological pregnancy. The presentation is similar to that of cruoric embolism, but it is characterized by local invasion and significant hematogenous dissemination leading to distant metastases. Increased Human chorionic gonadotropin hormone (hCG) levels are suggestive of the diagnosis. We report a case of choriocarcinomatous pulmonary embolism involving the inferior lobar artery of the left lung in a 44-year-old female patient admitted for multiple ischemic strokes. The diagnosis of choriocarcinoma was done on CT scan in the presence of high levels of Human chorionic gonadotropin hormone (hCG) contrasting with negative pelvic imaging and a history of previous spontaneous abortion. The outcome was favourable after chemotherapy which was an additional argument in favor of the diagnosis of choriocarcinoma.

Periprosthetic Joint Infection in Bilateral Knees Caused by Pasteurella multocida

Periprosthetic joint infection (PJI) is a well-described complication of joint arthroplasty. Pasteurella multocida is a rare cause of PJI that predominantly occurs after exposure to animals, primarily cats and dogs. There are only two described cases in the literature where multiple prostheses were simultaneously infected with P. multocida after hematogenous dissemination. We present the third described case of the synchronous infection of multiple prosthetic joints with P. multocida and describe the surgical and medical approaches utilized in treating this patient.

Bacteremia and adrenal gland abscess due to Nocardia cyriacigeorgica: a case report and review

BackgroundNocardia cyriacigeorgica is one of the most common Nocardia species found in human infections, recently reclassified. Even though Nocardia may affect all organs by hematogenous dissemination, bacteremia are uncommon. Among all possible dissemination sites, the involvement of the adrenal glands is particularly rare.Case presentationWe report here a rare case of Nocardia disseminated infection with notably bacteremia and adrenal gland abscess, in a 77-years-old immunocompetent man. Adrenal gland abscess diagnosis was made by imaging (computerized tomography, magnetic resonance and positron emission tomography scan). A complete regression of all lesions including the left adrenal gland was obtained after 6 months of antibiotics. A review of literature was also performed.ConclusionNocardia bacteremia is a rare event but blood cultures may help to improve detection of Nocardia spp. in a non-invasive way. Adrenal abscess due to Nocardia spp. is very rare with only fourteen cases reported in the literature, but it is a true cause of adrenal masses. Our report suggests that clinician should be aware of this rare location and prioritize a non-invasive diagnosis strategy.

384: ACTINOMYCES BRAIN ABSCESS AS SEQUELAE FROM PULMONARY ARTERIOVENOUS MALFORMATION: A CASE REPORT

Introduction: Most bacterial brain abscesses are a result of direct spread of bacteria, only a third are through hematogenous dissemination. A less common cause of hematogenous spread is via paradoxical embolism in the presence of a pulmonary arteriovenous malformation (PAVM). Currently PAVMs are not routinely screened for. Description: A 51-year-old male with past medical history of obstructive sleep apnea, and transient ischemic attack presented with left sided weakness. Initial CT head was concerning for subacute stroke. Patient’s physical exam was significant for 2/5 strength in left upper extremity, oral mucosa and skin findings were negative for telangiectasias. No significant family history reported. Initial white count negative. Worsening left sided numbness led to a repeat CT head which showed a 1.5 cm right posterior frontal/anterior mass lesion with surrounding edema. Patient underwent biopsy and drainage of brain abscess on hospital day 4, intraoperative pus was encountered. Patient was treated with ceftriaxone, metronidazole, and vancomycin. Cultures grew Actinomyces meyeri. On hospital day 8 a CT angiogram showed a PAVM in the medial middle lobe. Patient underwent right pulmonary artery angiogram on hospital day 12 which showed that the PAVM was fed by a branch of the right middle lobe pulmonary artery. After embolization follow-up angiogram showed cessation of flow through the PAVM. An MRI showed significantly less brain swelling around the cavity, based off the patient’s clinical and laboratory improvements patient was deemed stable for discharge to rehab facility on IV antibiotics. Discussion: A PAVM typically consists of afferent flow from a branch of the pulmonary artery to a branch of the pulmonary vein. Serious outcomes including strokes, seizures, and brain abscesses can arise from the right-to-left shunting of blood and paradoxical emboli. Most PAVMs are congenital associated with hereditary hemorrhagic telangiectasia, however, sporadic ones occur. Infections caused by Actinomyces are thought to induce hyperplastic changes in bronchial arteries which might lead to PAVMs. A PAVM should be considered in patients with a bacterial brain abscess and no identifiable site of infection. Treatment for PAVM include endovascular embolization vs thoracic surgery for removal.

Osteoarticular Mycoses.

Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.

A CASE OF DISSEMINATED TUBERCULOSIS IN A IMMUNOCOMPETENT PATIENT: TB MENINGITIS, PLEURAL TB, INTESTINAL/PERITONEAL TB

Disseminatedtuberculosis (TB)isdenedas thepresenceoftwo or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread or rarely through iatrogenic origin. Nowadays, the term miliary TB also refers to progressive and widely spread forms of pulmonary TB. It entails a hematogenous spreadofthediseasetoseveral organ.

The Cardiac Hydatid Cyst: A Case Report

Hydatid cyst commonly affects liver and lung. Cardiac hydatid cyst is an extremely rare disease, due to the development in the heart of the larval form of Taenia Echinococcus granulosus. The diagnosis of this location is difficult due to the absence of specific clinical signs, and its prognosis is often guarded due to the risk of rupture and hematogenous dissemination. Clinical polymorphism, latency and severity of complications are the essential characteristics. We report the case of a child who has this exceptional location of hydatic cyst. The aim of this study is to report the presentation and management of cardiac Hydatid diseases.

Spondylodiscitis Associated with Multiple Vascular Accesses for Hemodialysis

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.