Diabetic foot complicated by vertebral osteomyelitis and epidural abscess

Summary Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement of the foot infection, high fever and lower back pain continued. Bone biopsy and two consecutive blood cultures were positive for Staphylococcus aureus. A spinal magnetic resonance imaging (MRI) was performed, revealing serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Contiguous or other distant focuses of infection were not identified. In this case, diabetic foot could be considered as a primary distant focus for vertebral osteomyelitis. Clinicians should consider vertebral osteomyelitis as a ‘possible’ diagnosis in patients with type 2 diabetes complicated by foot infection that is associated with fever and lower back pain. Learning points Vertebral osteomyelitis is increasing in Western countries, especially in patients with type 2 diabetes. The primary focus of infection is the genitourinary tract followed by skin, soft tissue, endocarditis, bursitis, septic arthritis, and intravascular access. Diabetic foot could be a rare primary focus of infection for vertebral osteomyelitis, and, however, vertebral osteomyelitis could be a serious, albeit rare, complication of diabetic foot. Clinicians should keep in mind the many potential complications of diabetic foot ulcerations and consider vertebral osteomyelitis as a “possible” diagnosis in patients with type 2 diabetes and foot ulcers associated with nonspecific symptoms such as lower back pain. Early diagnosis and correct management of vertebral osteomyelitis are crucial to improve clinical outcomes.

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Vertebral osteomyelitis in an adolescent girl

SAGE Open Medical Case Reports ◽

10.1177/2050313x20949781 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2094978

Author(s):

Shafee Salloum

Keyword(s):

Differential Diagnosis ◽

Back Pain ◽

Blood Culture ◽

Early Diagnosis ◽

Lower Back Pain ◽

Bacterial Growth ◽

Adolescent Girl ◽

Surgical Intervention ◽

Vertebral Osteomyelitis ◽

Lower Back

We present a case of a 13-year-old girl with vertebral osteomyelitis. She had been experiencing lower back pain for 5 weeks, initially thought to be due to muscular causes. The blood culture showed no bacterial growth, and she was treated empirically only with antibiotics. She responded well to treatment and required no surgical intervention. Vertebral osteomyelitis should be in the differential diagnosis in an adolescent who complains of worsening lower back pain. Early diagnosis and treatment are essential in avoiding complications.

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Recurrent spondylodiscitis secondary to hallux osteomyelitis

British Journal of Diabetes ◽

10.15277/bjd.2019.217 ◽

2019 ◽

Vol 19 (1) ◽

pp. 63-65

Author(s):

Aleksandra Staniszewska ◽

Elizabeth Ballingall ◽

Peter Schnatterbeck ◽

Christopher R Lattimer ◽

Amit Amin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Differential Diagnosis ◽

Back Pain ◽

Thoracic Spine ◽

Diabetic Foot ◽

Diabetic Foot Infection ◽

Local Disease ◽

Severe Back Pain

Foot infections are the commonest complication of diabetes mellitus requiring hospitalisation. Despite local osteomyelitis being the most frequent sequel of a diabetic foot infection, there is emerging evidence to suggest that local disease may lead to distant infections. In this report we present a case of recurrent thoracic spine spondylodiscitis due to left hallux osteomyelitis in a man with type 2 diabetes. This case illustrates the importance of considering spondylodiscitis as a differential diagnosis in patients presenting with diabetic foot infection and complaining of acute severe back pain.

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Vertebral osteomyelitis due to Salmonella Poona in a healthy adolescent female

SAGE Open Medical Case Reports ◽

10.1177/2050313x20969017 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2096901

Author(s):

Yalda Toofan ◽

Samiksha Tarun ◽

Jonathan D Bender ◽

Sarah A Auerbach ◽

David A Stewart ◽

...

Keyword(s):

Back Pain ◽

Lower Back Pain ◽

Bone Biopsy ◽

Vertebral Osteomyelitis ◽

The United States ◽

Healthy Adolescent ◽

Lower Back ◽

Spinal Imaging ◽

Food Borne ◽

Traditional Risk Factors

We present a case of vertebral osteomyelitis in a previously healthy, adolescent Caucasian female athlete. After months of lower back pain, spinal imaging demonstrated phlegmon and suspected osteomyelitis of the L4 vertebral body. A bone biopsy was obtained, and microbiologic cultures yielded pure growth of Salmonella enterica subsp. enterica serovar Poona ( S. Poona), a member of the nontyphoid Salmonella group associated with food-borne gastroenteritis in the United States. This case represents the first reported association of S. Poona with osteomyelitis and is interesting in that the infection developed in a patient without traditional risk factors for invasive Salmonella disease (i.e. sickle cell disease). This case highlights the importance of keeping a broad differential diagnosis for lower back pain and emphasizes the value of obtaining specimens for microbiologic culture to aid in diagnosing non-traditional and potentially emerging bacterial pathogens.

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Acute Lower Back Pain

10.2310/em.4023 ◽

2015 ◽

Author(s):

John W. Martel ◽

Caitlin Hynes

Keyword(s):

Back Pain ◽

Lower Back Pain ◽

Nerve Root ◽

Epidural Abscess ◽

The United States ◽

Magnetic Resonance Images ◽

Disk Herniation ◽

Lower Back ◽

Acute Back Pain ◽

Acute Lower Back Pain

Lower back pain is common, with up to 8% of the adult population in the United States reporting at least one episode of acute back pain within the last year. This is associated with considerable burden to the health care system. The majority of patients who experience back pain have no clear etiology for their symptoms; although symptoms tend to improve within 4 to 6 weeks, they also tend to recur. This review covers the pathophysiology, diagnosis and treatment, and disposition and outcomes of acute lower back pain. Figures show magnetic resonance images of L4/L5 disk herniation, spinal neoplasm, and epidural abscess; schematics of cauda equina syndrome associated with central disk herniation and disk herniation causing unilateral radicular symptoms due to nerve root compression; and dermatomal symptoms associated with L4-S1 nerve root compromise. Tables list red flag signs and symptoms of acute back pain, emergent causes of acute back pain, Waddell signs suggestive of nonorganic back pain, neurologic examination findings associated with L1-S1 nerve roots, pros and cons of treatment options for musculoskeletal and radicular back pain, and indications for surgery for patients with spinal epidural abscess and vertebral osteomyelitis. This review contains 5 highly rendered figures, 6 tables, and 98 references.

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