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Pyogenic cervical osteomyelitis presenting as a massive prevertebral abscess in a patient with rheumatoid arthritis
H McGrath1, C McCormick, M E Carey
1Department of Medicine, Louisiana State University School of Medicine, New Orleans.
Abstract:
Pre-existing rheumatoid arthritis appeared to have masked the diagnosis and contributed to a succession of hazardous events in a 58-year-old man with pyogenic cervical osteomyelitis. A massive prevertebral abscess and near asphyxiation finally led to the diagnosis of an indolent Staphylococcus aureus infection in a course marked by antecedent staphylococcal sepsis, a series of dangerous cervical spine chiropractic manipulations in the presence of advanced bony destruction, and, ultimately, cervical spine bony collapse and gibbus formation. The absence of myelopathy despite long-standing progressive advanced destruction is noteworthy. The roentgenologic documentation of this progression was unique. This appears to be the first fully documented case of cervical spine osteomyelitis presenting as a prevertebral abscess in a patient with rheumatoid arthritis.
Insights
Rheumatoid arthritis masked pyogenic cervical osteomyelitis in a man, leading to a prevertebral abscess. This case highlights a rare presentation of Staphylococcus aureus infection with significant spinal destruction but no myelopathy.
Area of Science:
- Infectious Diseases
- Rheumatology
- Orthopedic Surgery
Background:
- Rheumatoid arthritis (RA) can complicate infectious disease diagnosis.
- Pyogenic cervical osteomyelitis is a rare but serious spinal infection.
Observation:
- A 58-year-old male with RA presented with symptoms suggestive of a prevertebral abscess.
- The patient experienced antecedent staphylococcal sepsis and underwent cervical spine manipulations.
- Advanced bony destruction of the cervical spine was noted, leading to collapse and gibbus formation.
Findings:
- The diagnosis of indolent Staphylococcus aureus cervical osteomyelitis was challenging due to RA.
- A massive prevertebral abscess and near asphyxiation were key diagnostic indicators.
- Remarkably, the patient showed no signs of myelopathy despite extensive spinal destruction.
Implications:
- This case underscores the importance of considering spinal infections in RA patients with atypical presentations.
- The unique roentgenologic documentation provides valuable insights into the progression of cervical osteomyelitis.
- This is the first documented case of cervical osteomyelitis presenting as a prevertebral abscess in a patient with rheumatoid arthritis.