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Thoracic Discitis in Ankylosing Spondylitis.

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Summary

Ankylosing spondylitis can cause rare complications like cauda equina syndrome and discitis. Differentiating between infection and inflammation is challenging, necessitating empirical antibiotic treatment alongside potential biologics.

Keywords:
ankylosing spondylitiscauda equina syndromethoracic discitis

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Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Chronic ankylosing spondylitis (AS) can lead to rare but severe complications such as cauda equina syndrome and discitis.
  • Early diagnosis and treatment are crucial, yet distinguishing infectious from inflammatory etiologies can be difficult.

Observation:

  • A 52-year-old male with a 30-year history of undiagnosed AS presented with cauda equina syndrome and thoracic discitis.
  • Initial diagnostic workup, including multiple imaging and cultures, was inconclusive in determining an infectious cause for the discitis.

Findings:

  • Despite negative cultures, a six-week course of broad-spectrum antibiotics (vancomycin and cefepime) was administered empirically.
  • The patient showed clinical improvement after surgery and was subsequently initiated on adalimumab (a TNF inhibitor) for his ankylosing spondylitis.

Implications:

  • This case underscores the diagnostic challenges in differentiating infectious versus inflammatory discitis in AS patients.
  • Empirical antibiotic treatment is often necessary in such cases due to the lack of definitive diagnostic tests.
  • Careful consideration is required before initiating biologic therapy to avoid exacerbating an undiagnosed infection.