A Fatal Case of Spondylodiscitis Complicated by Aortic Fistulization and Mycotic Pseudoaneurysm Formation

Spondylodiscitis, a pyogenic infection of the intervertebral disc and adjacent vertebral bodies, is an uncommon but serious condition that may progress to life-threatening vascular complications when the infective process erodes into adjacent great vessels. We report the case of a 60-year-old woman who presented with a three-week history of severe, progressive low back pain, high-grade fever, and chills. Laboratory workup revealed marked leukocytosis and a markedly elevated C-reactive protein level, and blood cultures yielded Staphylococcus aureus (S. aureus). MRI of the thoracolumbar spine demonstrated T12-L1 infectious spondylodiscitis with an anteriorly extending destructive inflammatory tract that was shown on MRI to form a direct fistula into the abdominal aorta, associated with a large mycotic pseudoaneurysm. Emergency aortic repair was planned; however, the patient deteriorated rapidly and developed refractory septic shock, dying within hours of diagnosis. This report underscores the catastrophic potential of vertebral osteomyelitis when complicated by aortic fistulization and mycotic pseudoaneurysm formation, highlights the diagnostic value of contrast-enhanced MRI, and emphasizes the need for early multidisciplinary intervention for such critically ill patients.