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
References
[1]
V. Dufour, A. Feydy, L. Rillardon et al., “Comparative study of postoperative and spontaneous pyogenic spondylodiscitis,” Seminars in Arthritis and Rheumatism, vol. 34, no. 5, pp. 766–771, 2005.
[2]
T. Gouliouris, S. H. Aliyu, and M. N. Brown, “Spondyliodiscitis: update on diagnosis and management,” Journal of Antimicrobial Chemotherapy, vol. 65, pp. 11–24, 2010.
[3]
A. Dagirmanjian, J. Schils, M. McHenry, and M. T. Modic, “MR imaging of vertebral osteomyelitis revisited,” American Journal of Roentgenology, vol. 167, pp. 1539–1543, 1996.
[4]
E. Lucio, A. Adesokan, A. G. Hadjipavlou, W. N. Crow, and P. A. Adegboyega, “Pyogenic spondylodiscitis: a radiologic/pathologic and culture correlation study,” Archives of Pathology & Laboratory Medicine, vol. 124, pp. 712–716, 2000.
[5]
E. Legrand, R. M. Flipo, P. M. C. Guggenbuhl et al., “Management of nontuberculous infectious discitis. Treatments used in 110 patients admitted to 12 teaching hospitals in France,” Joint Bone Spine, vol. 68, no. 6, pp. 504–509, 2001.
[6]
N. Yazici, B. Yal？in, A. Cila, A. Alnay, and M. Büyükpamuk？u, “Discitis following lumbar puncture in non-Hodgkin lymphoma,” Pediatric Hematology-Oncology, vol. 22, pp. 689–694, 2005.
[7]
I. Z. Abolnik, J. V. Eaton, and D. J. Sexton, “Propionibacterium acnes vertebral osteomyelitis following lumbar puncture: case report and review,” Clinical Infectious Diseases, vol. 21, no. 3, pp. 694–695, 1995.
[8]
I. Bergman, E. R. Wald, J. D. Meyer, and M. J. Painter, “Epidural abscess and vertebral osteomyelitis following serial lumbar punctures,” Pediatrics, vol. 72, no. 4, pp. 476–480, 1983.
[9]
Y. Demiraran, M. D？？o？lu, C. Yavuz, and F. Akyüz, “Spondilodiscitis and lumbar epidural abscess occurring after orthopedic epidural anesthesia: a case report,” Turkish Neurosurgery, vol. 16, no. 4, pp. 208–211, 2006.
[10]
E. Jakab, R. Zbinden, J. Gubler, C. Ruef, A. von Graevenitz, and M. Krause, “Severe infections caused by Propionibacterium acnes: an underestimated pathogen in late postoperative infections,” Yale Journal of Biology and Medicine, vol. 69, no. 6, pp. 477–482, 1996.
[11]
M. E. Jimenez-Mejias, J. de Dios Colmenero, F. J. Sanchez-Lora, et al., “Postoperative spondylodiscitis: etiology, clinical findings, prognosis and comparison with non-operative pyogenic spondylodiscitis,” Clinical Infectious Diseases, vol. 29, pp. 339–345, 1999.
[12]
C. Kindler, M. Seeberger, M. Siegemund, and M. Schneider, “Extradural abscess complicating lumbar extradural anaesthesia and analgesia in an obstetric patient,” Acta Anaesthesiologica Scandinavica, vol. 40, no. 7, pp. 858–861, 1996.
[13]
A. R. Mackenzie, R. B. S. Laing, C. C. Smith, G. F. Kaar, and F. W. Smith, “Spinal epidural abscess: the importance of early diagnosis and treatment,” Journal of Neurology Neurosurgery and Psychiatry, vol. 65, no. 2, pp. 209–212, 1998.
[14]
A. G. Jensen, F. Espersen, P. Skinhoj, and N. Frimodt-Moller, “Bacteremic staphylococcus aureus spondylitis,” Archives of Internal Medicine, vol. 158, pp. 509–517, 1998.
[15]
G. M. Vilke and E. A. Honingford, “Cervical spine epidural abscess in a patient with no predisposing risk factors,” Annals of Emergency Medicine, vol. 27, no. 6, pp. 777–780, 1996.
[16]
R. L. Danner and B. J. Hartman, “Update on spinal epidural abscess: 35 cases and review of the literature,” Reviews of Infectious Diseases, vol. 9, no. 2, pp. 265–274, 1987.
[17]
A. G. Hadjiipavlou, J. T. Mader, J. T. Necessary, and A. J. Muffoletto, “Hematogenous pyogenic spinal infections and their surgical management,” Spine, vol. 25, pp. 1668–1679, 2000.
[18]
J. D. Colmenero, M. E. Jimenez-Mejias, F. J. Sanchez-Lora, et al., “Pyogenic, tuberculous and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases,” Annals of the Rheumatic Diseases, vol. 56, pp. 709–715, 1997.
[19]
S. K. Malawski and S. Lukawski, “Pyogenic infection of the spine,” Clinical Orthopaedics and Related Research, vol. 272, pp. 58–66, 1991.
[20]
C. Perronne, J. Saba, Z. Behloul et al., “Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients,” Clinical Infectious Diseases, vol. 19, no. 4, pp. 746–750, 1994.
[21]
R. J. Martin and H. A. Yuan, “Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis,” Orthopedic Clinics of North America, vol. 27, no. 1, pp. 125–136, 1996.
