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Recurrent pyogenic vertebral osteomyelitis associated with type 2 diabetes mellitus
1Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan.
The Journal of International Medical Research
|December 1, 2001
Summary
Recurrent pyogenic vertebral osteomyelitis in a diabetic patient highlights the need for extended antibiotic therapy. Continued treatment is crucial even after inflammation signs subside to prevent relapse.
Area of Science:
- Infectious Diseases
- Endocrinology
- Radiology
Background:
- Pyogenic vertebral osteomyelitis (PVO) is a serious spinal infection.
- Type 2 diabetes mellitus (T2DM) is a common comorbidity that can complicate infections.
- Staphylococcus aureus is a frequent causative pathogen in PVO.
Observation:
- A 51-year-old male with T2DM presented with back pain, fatigue, and foot ulcers.
- Blood and ulcer cultures identified Staphylococcus aureus.
- Gallium scintigraphy and MRI revealed vertebral inflammation at Th8-Th9.
Findings:
- Initial antibiotic treatment and insulin therapy led to decreased C-reactive protein levels.
- MRI showed resolved inflammatory changes, prompting antibiotic discontinuation.
- The patient experienced a rapid relapse with acute inflammatory changes at the same spinal site.
Implications:
- This case underscores the importance of prolonged antibiotic therapy in PVO, especially in diabetic patients.
- Discontinuation of antibiotics solely based on normalized inflammatory markers may lead to recurrence.
- Extended complementary antibiotic treatment is vital for successful PVO management.