%0 Journal Article
%T Spondylodiscitis Occurring after Diagnostic Lumbar Puncture: A Case Report
%A Mehmet Sabri G¨¹rb¨¹z
%A Mehmet Zafer Berkman
%J Case Reports in Infectious Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/843592
%X Spondylodiscitis is a rare disease which is generally seen after long-term epidural catheterization. However, spondylidiscitis developing after diagnostic lumbar puncture is very rare. Early diagnosis has a crucial role in the management of the disease and inclines the morbidity rates. However, the diagnosis is often delayed due to the rarity and insidious onset of the disease usually presenting with low back pain which has a high frequency in the society. If it is diagnosed early before development of an abscess requiring surgery or neurological deficit, it responds to antimicrobial therapy quite well. We report 66-year-old male case of spondylodiscitis developing after diagnostic lumbar puncture. The patient was treated with antimicrobial therapy. After antimicrobial therapy, findings of spondylodiscitis were completely resolved and no recurrence was seen in the period of 9-month followup. 1. Introduction Spondylodiscitis is characterized by vertebral osteomyelitis, spondylitis, and discitis. Diagnosis is made with the combination of clinical, radiological, and laboratory findings. Patients present with persistent low back pain, fever, or neurological findings [1, 2]. MRI has high sensitivity and specificity in diagnosis of spondylodiscitis [2, 3] and can reveal signs of spondylodiscitis in even very early stages [3, 4]. Spondylodiscitis responds to antimicrobial therapy well if diagnosed early before the development of neurological deficit and requirement of surgical intervention [2, 5, 6]. We reported a rare case of iatrogenic spondylodiscitis developing after diagnostic lumbar puncture. The patient was diagnosed early and successfully treated with antimicrobial therapy. 2. A Case Report 66-years-old male patient was admitted with 3-month history of gait disturbance, urinary incontinence, and mental decline. In cranial CT and MRI scans normal pressure hydrocephalus was suspected, and diagnostic lumbar puncture was done three times every other day. Patient complained of low back pain after the third puncture. Systemic examination was unremarkable. There was no fever. Laboratory examination revealed elevated erythrocyte sedimentation rate (80£¿mm/h) and C-reactive protein level (3.6£¿mg/L) with 9.5 109/L white blood cells. Lumbar MRI scan was done, and lumbar spondylodiscitis was detected (Figure 1(A). Figure 1: (A) Discitis and osteomyelitis are seen on this T2-weighted MR image of the lumbar spine which demonstrates infective destruction of the L4-5 disk space with the adjacent L4 and L5 vertebral bodies. (B) T2-weighted MR image of the lumbar spine
%U http://www.hindawi.com/journals/criid/2013/843592/