[A case of cervical pyogenic spondylitis difficult to differentiate from metastatic spinal tumor]

A 52-year-old man with medical complications of diabetic mellitus and alcoholic liver dysfunction, presented with weakness in the bilateral lower extremities. Cervical magnetic resonance images disclosed the lesion extended from retropharyngeal space and multiple vertebral bodies to epidural space of the spinal canal, which was enhanced by gadolinium. Not only fever elevation during clinical course but also inflammatory reaction on selologic examination were not identified, so we initially thought the lesion metastatic spinal tumor. In researching original foci, his clinical condition worsened with gate disturbance and urinary incontinence. Eleven days later after admission, laminectomy from C-5 to Th-1 and open biopsy of the lesion was performed. The vertebral bodies exposed via the right frontal approach were covered by thick whitish membrane. Small mount of pus emerged after incision of the membrane, so we diagnosed the lesion pyogenic spondylitis. After the operation, high dose antibiotic therapy for 6 weeks was performed. Follow-up cervical MR imaging 4 months after the operation found that the volume of the lesion and compression of the spinal cord were reduced. The gate disturbance and urinary incontinence gradually improved, he was able to walk with a cane 6 months later.