Lumbar discitis in a patient with quadriplegia: case report

The diagnosis of septic discitis, or vertebral osteomyelitis, in able-bodied adults is difficult to make and often delayed. Here, the clinical findings and events leading to diagnosis and complications of septic discitis occurring in a patient with quadriplegia after urinary tract manipulation are presented. The diagnosis was delayed nine weeks from onset of fever (11 weeks after urologic manipulation), despite a variety of radiologic procedures and repeated blood and urine cultures. The patient's symptoms recurred five weeks after IV antibiotics were discontinued and while he was still taking oral cephalexin. He underwent open debridement and further IV and IM tobramycin, recovering without complication. The patient died five months later, reportedly of bowel obstruction and pneumonia. A review of the literature revealed only one other case report, of a patient with paraplegia, who also presented a diagnostic problem and died one year after diagnosis.