Abstract
Study design:
Case report.
Objective:
Vertebral osteomyelitis, usually presented with back pain and local tenderness, can pose a great challenge of early diagnosis among spinal cord injury (SCI) patients who lost sensation below the injured level. We reported a paraplegic patient who had recurrent febrile episodes after being treated as urinary tract infection initially and was discovered later to have vertebral osteomyelitis.
Case report:
A 41-year-old man, completely paralyzed at the T11 level and with Foley catheterization for 9 years, was re-admitted within 2 weeks for recurrent fever, turbid urine, bacteriuria and bacteremia with Escherichia coli. Spine X-ray and renal, cardiac and abdominal ultrasonography showed no definite lesions related to infection in a previous admission. Intermittently febrile episodes continued despite treatment with antibiotics for 1 week. He had no pressure sores or other wounds. Computerized tomography and magnetic resonance imaging showed lumbosacral osteomyelitis and bilateral paravertebral abscess. The patient underwent debridement of paravertebral tissue. Fever subsided soon after surgery and the patient continued antibiotics and remained free of fever at a 1-year follow-up.
Conclusion:
It can be challenging to diagnose vertebral osteomyelitis below injury levels in SCI patients. Vertebral osteomyelitis should be considered in febrile SCI patients even with known infectious foci, as classic symptoms of osteomyelitis are lacking in this population.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Frisbie JH, Gore RL, Strymish JM, Garshick E . Vertebral osteomyelitis in paraplegia: incidence, risk factors, clinical picture. J Spinal Cord Med 2000; 23: 15–22.
Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A . Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39: 10–17.
Malik GM, Sapico FL, Montgomerie JZ . Severe vertebral osteomyelitis in patients with spinal cord injury. Arch Intern Med 1982; 142: 807–808.
Kern RZ, Houpt JB . Pyogenic vertebral osteomyelitis: diagnosis and management. Can Med Assoc J 1984; 130: 1025–1028.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Hsiao, MY., Liang, HW. Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient. Spinal Cord 49, 1020–1022 (2011). https://doi.org/10.1038/sc.2011.39
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2011.39
Keywords
This article is cited by
-
Beyond broken spines–what the radiologist needs to know about late complications of spinal cord injury
Insights into Imaging (2015)
