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Rheumatology 2007 46(8):1296; doi:10.1093/rheumatology/kem110
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

An unusual case of infectious spondylodiscitis

E. J. A. Kroot1,2 and J. M. W. G. Wouters2

1Department of Rheumatology, Máxima Medical Centre, Eindhoven and 2Department of Rheumatology, St. Franciscus Hospital, Rotterdam, The Netherlands

Correspondence to: Eric-Jan A. Kroot. E-mail: e.kroot{at}mmc.nl

A 28-yr-old man was admitted because of low back pain and a markedly increased erythrocyte sedimentation rate. Magnetic resonance imaging (MRI) was characteristic of L5–S1 spondylodiscitis. Repeated needle aspirations of this region yielded no microorganisms. Because of a strong suspicion of infectious spondylodiscitis, patient received several broad-spectrum intra-venous antibiotics, however, without improvement. Additional fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated abnormal hypermetabolism at L5–S1, and, remarkably, in a large area surrounding these vertebrae (arrows in Fig. 1A and B) [1]. Extension of this area into the direction of the gastrointestinal system could be suspected (Fig. 1B) [2]. The area surrounding the vertebrae, not previously detected by MRI, was punctured and a mixture of microorganisms, including Enterobacter cloacae, {alpha}-haemolytic streptococci and Candida albicans was found. Then the antibiotic regimen was adjusted into linezolid, colistine and fluconazole. In addition, as the observed flora was very likely of intestinal origin, a colonoscopy with ileoscopy was performed. This showed an abnormal mucosal pattern of the terminal ileum, which was surgically removed. Histological examination of the resected specimen revealed Crohn's disease with fistulae into the muscles. The patient had an uneventful post-operative course and is doing well up to now.


Figure 1
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  		FIG. 1. FDG-PET demonstrating abnormal hypermetabolism at L5–S1 (A) and in a large area surrounding these vertebrae, with a suspected extension into the gastrointestinal system (A and B).

 
The authors have declared no conflicts of interest.

References

  1. Sciuk J. Scintigraphic techniques for the diagnosis of infectious disease of the musculoskeletal system. Semin Musculoskelet Radiol (2004) 8:205–13.[CrossRef][Web of Science][Medline]
  2. Neurath MF, Vehling D, Schunk K, et al. Noninvasive assessment of Crohn's disease activity: a comparison of 18F-fluorodeoxyglucose positron emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies. Am J Gastroenterol (2002) 97:1978–85.[CrossRef][Web of Science][Medline]
Accepted 9 March 2007


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This Article
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