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Septic discitis: an important cause of back pain
Prakashchandra Patel1, Kenneth E Olive, Koyamangalath Krishnan
1Division of Hematology-Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN 37614, USA.
Southern Medical Journal
|August 28, 2003
Summary
A 65-year-old immunocompromised patient developed severe back pain due to Staphylococcus epidermidis disk infection after chemotherapy. Early diagnosis and treatment with vancomycin and levofloxacin are crucial for managing this condition.
Area of Science:
- Infectious Diseases
- Oncology
- Radiology
Background:
- The case highlights a rare complication in an immunocompromised patient previously treated for non-Hodgkin's lymphoma.
- Post-chemotherapy complications included febrile neutropenia, recurrent bacteremia, and infections.
Observation:
- The patient presented with intractable lower back pain, requiring high-dose narcotic analgesia.
- Magnetic resonance imaging (MRI) of the spine suggested disk infection.
Findings:
- Fluoroscopically guided needle aspiration confirmed disk space infection.
- Blood and tissue cultures identified coagulase-negative Staphylococcus species, specifically Staphylococcus epidermidis.
- Treatment involved intravenous vancomycin and oral levofloxacin.
Implications:
- Septic discitis is a critical differential diagnosis for back pain, especially in patients with bacteremia.
- While Staphylococcus aureus is common, Staphylococcus epidermidis should be considered in immunocompromised individuals.
- This case underscores the importance of considering unusual pathogens in post-chemotherapy patients with persistent infections.
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