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Infective Spondylodiscitis of Unknown Origin in a Patient with Chronic Kidney Disease - Case report
Jenil Patel1, Maitreya Patil1, Vishnu Vikraman Nair1
1Department of Orthopaedics and Spine Surgery, Bombay Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
Introduction:
Infective spondylodiscitis, resulting from bacterial or fungal infections in intervertebral discs and adjacent vertebral bodies, poses diagnostic dilemmas due to its rare occurrence and subtle symptomatology. This report underscores the importance of a multidisciplinary approach in navigating the complexities of infective spondylodiscitis, particularly in patients with concomitant chronic kidney disease (CKD).
Case Report:
A 53-year-old male, 5 years into renal dialysis for CKD, presented with a 3-month history of severe neck pain radiating to both arms, accompanied by tingling sensations. Neurological evaluation revealed weakness and gait imbalance. Laboratory findings indicated elevated serum creatinine, erythrocyte sedimentation rate, and C-reactive protein. Imaging confirmed vertebral destruction, necessitating a staged treatment plan involving surgical intervention, corpectomy, mesh placement, and fusion. Intraoperative cultures yielded negative results, prompting continued broad-spectrum antibiotic therapy intravenously for 2 weeks, followed by an additional 4 weeks orally.
Discussion:
The case discussion explores common risk factors for infective spondylodiscitis, emphasizing the need for a comprehensive diagnostic approach in patients with immunocompromised conditions, such as CKD. Despite negative cultures, the patient's favorable clinical response and neurological recovery underscore the intricate nature of infectious processes, especially in individuals with underlying health concerns.
Conclusion:
This case report serves as a poignant reminder of the challenges associated with infective spondylodiscitis in CKD patients on hemodialysis. The classic triad of pain, fever, and neurological deficits should trigger a thorough diagnostic investigation, leveraging advanced imaging techniques for accurate diagnosis. A multidisciplinary approach and regular follow-ups are essential in managing such complex cases, contributing to improved patient outcomes and overall healthcare quality.
Insights
Infective spondylodiscitis in chronic kidney disease (CKD) patients presents diagnostic challenges. Early recognition and a multidisciplinary approach are crucial for effective management and improved patient outcomes.
Area of Science:
- Spine Surgery
- Infectious Diseases
- Nephrology
Background:
- Infective spondylodiscitis is a rare spinal infection often presenting with subtle symptoms, complicating diagnosis.
- Patients with chronic kidney disease (CKD) and those on renal dialysis are at increased risk due to immunocompromised status.
Observation:
- A 53-year-old male on long-term dialysis for CKD presented with severe neck pain, neurological deficits, and elevated inflammatory markers.
- Imaging revealed significant vertebral destruction, necessitating surgical intervention including corpectomy, mesh placement, and fusion.
Findings:
- Despite negative intraoperative cultures, the patient showed clinical improvement and neurological recovery with a prolonged course of broad-spectrum antibiotics.
- This highlights the complexity of diagnosing and treating spinal infections in immunocompromised individuals, even without definitive microbiological evidence.
Implications:
- This case emphasizes the importance of a high index of suspicion for infective spondylodiscitis in CKD patients presenting with spinal pain and neurological symptoms.
- A multidisciplinary approach involving surgeons, infectious disease specialists, and nephrologists, coupled with advanced imaging and tailored treatment, is vital for optimal management.
- Early diagnosis and intervention are critical for preventing severe neurological complications and improving outcomes in this vulnerable patient population.
