Lumbosacral spondylodiscitis complicated by sepsis, osteomyelitis, epidural abscess formation and deep vein thrombosis

BMJ Case Rep. 2020 Dec 28;13(12):e238522. doi: 10.1136/bcr-2020-238522.

Abstract

A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2-3 and L5-S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient's clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.

Keywords: bone and joint infections; interventional radiology; radiology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Discitis / complications*
  • Discitis / diagnostic imaging
  • Drainage
  • Epidural Abscess / complications*
  • Epidural Abscess / diagnosis
  • Epidural Abscess / drug therapy
  • Humans
  • Low Back Pain / etiology
  • Lumbar Vertebrae* / diagnostic imaging
  • Magnetic Resonance Imaging
  • Male
  • Osteomyelitis / complications*
  • Osteomyelitis / diagnosis
  • Osteomyelitis / drug therapy
  • Psoas Abscess / complications
  • Psoas Abscess / diagnostic imaging
  • Psoas Abscess / drug therapy
  • Sacrum* / diagnostic imaging
  • Sepsis / complications*
  • Sepsis / diagnosis
  • Sepsis / drug therapy
  • Staphylococcal Infections / complications*
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / drug therapy
  • Tomography, X-Ray Computed
  • Venous Thrombosis

Substances

  • Anti-Bacterial Agents