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[Lumbar spondylodiscitis caused by Salmonella enteritidis]
A Schüler1, D Schaumann, M P Manns
1Abteilung Gastroenterologie und Hepatologie, Zentrum Innere Medizin der Medizinischen Hochschule Hannover.
Deutsche Medizinische Wochenschrift (1946)
|October 14, 1994
Summary
A rare case of Salmonella spondylodiscitis in a young male, initially misdiagnosed as borreliosis due to cross-reacting antibodies, highlights the importance of comprehensive diagnostics for infectious spondylitis.
Area of Science:
- Infectious Diseases
- Orthopedics
- Microbiology
Background:
- Salmonellosis is a common bacterial infection, typically causing gastrointestinal symptoms.
- Spondylodiscitis, an infection of the spine and intervertebral discs, is an uncommon but serious complication of salmonellosis.
- Accurate diagnosis can be challenging due to atypical presentations and potential for cross-reactivity in serological tests.
Observation:
- A 19-year-old male presented with lumbar pain, fever, and meningism after strenuous exercise.
- Initial investigations revealed reactive pleocytosis and moderately elevated erythrocyte sedimentation rate, with positive Borrelia antibodies leading to a suspected diagnosis of borreliosis.
- Subsequent fever spikes and rising Salmonella antibody titers, alongside positive blood cultures for Salmonella enteritidis, indicated salmonellosis as the causative agent.
Findings:
- Imaging studies (CT and MRI) confirmed spondylodiscitis of lumbar vertebrae 1 and 2 with osteolysis.
- The patient's white blood cell count remained normal throughout the illness.
- Treatment with ciprofloxacin and supportive care led to complete resolution of the spinal lesion.
Implications:
- This case underscores the potential for Salmonella to cause spondylodiscitis long after initial gastrointestinal symptoms.
- Serological cross-reactivity between Borrelia and Salmonella antigens can lead to diagnostic delays and misdiagnosis.
- Comprehensive diagnostic workup, including blood cultures and advanced imaging, is crucial for identifying uncommon complications of salmonellosis.