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Spinal osteomyelitis presenting with a life-threatening pleural empyema
S Jari1, A el-Gamel, T H Meadows
1Department of Orthopaedic, Wythenshawe Hospital, South Manchester, United Kingdom.
Spine
|December 1, 1996
Summary
This case report highlights a rare presentation of spinal osteomyelitis initially misdiagnosed as cancer due to a life-threatening pleural empyema. Prompt diagnosis and antibiotic treatment led to a full recovery.
Area of Science:
- Infectious Diseases
- Pulmonology
- Orthopedic Surgery
Background:
- Spinal osteomyelitis can present atypically, mimicking malignancy.
- Pleural effusions are rare complications of vertebral osteomyelitis, with empyema being exceptionally uncommon.
- Literature review reveals limited cases of vertebral osteomyelitis associated with pleural effusions, and only one prior case of empyema.
Observation:
- A patient initially suspected of having bronchogenic carcinoma with vertebral metastasis developed a life-threatening pleural effusion.
- Further investigation revealed the underlying cause to be spinal osteomyelitis with a concurrent pleural empyema.
- The patient's presentation led to a misdiagnosis before the true etiology was identified.
Findings:
- The pleural empyema was successfully managed with chest tube drainage and appropriate antibiotics.
- The patient experienced a complete and uneventful recovery following targeted treatment.
- This case underscores the diagnostic challenges posed by vertebral osteomyelitis presenting with empyema.
Implications:
- A high index of suspicion is crucial for diagnosing spinal osteomyelitis, especially in cases with unusual presentations.
- Accurate and timely diagnosis is essential to prevent inappropriate management and potential adverse outcomes.
- Early and correct management of spinal osteomyelitis with empyema leads to an excellent prognosis.