Van der Wal W A, Oner F C
Universitair Medisch Centrum Utrecht, Postbus 85,500, 3508 GA Utrecht.
Ned Tijdschr Geneeskd. 2007 Nov 10;151(45):2485-90.
An 83-year-old woman was admitted to hospital with complaints of fever, abdominal pain and other complaints suggesting urosepsis. Additional analyses did not reveal the cause of her complaints. After cessation of antibiotic therapy, there was a spontaneous decrease in the infection parameters and she was subsequently discharged. Two and a half months later she was presented in our hospital with low back pain with radiating to the legs. MRI showed signs ofa spondylodiscitis at the level of LIII-LIV existing for some time. Finally, a gram-positive streptococcus infection was found and she was treated with antibiotics for 13 weeks. 6 months later she was free of symptoms. A 57-year-old man was admitted to the intensive care with a double-sided olecranon bursitis and sepsis. An endocarditis caused by Staphylococcus aureus was thought to be the cause of the sepsis and the patient was treated with surgical intervention and antibiotics. Because of persistent sepsis, different CT-scans were performed, and after one and a half months an extensive spondylodiscitis with abscess formation was diagnosed and subsequently treated surgically. A delay in diagnosing spondylodiscitis is the rule rather the exception. The diagnosis should be considered in any patient with localised back pain, especially when accompanied by fever, high ESR, and the presence of risk factors such as high age, diabetes mellitus, immunosuppression, and/or rheumatoid arthritis.
一名83岁女性因发热、腹痛及其他提示泌尿道感染的症状入院。进一步检查未发现其症状的病因。停止抗生素治疗后，感染指标自发下降，随后她出院了。两个半月后，她因腰痛并放射至腿部前来我院就诊。磁共振成像（MRI）显示腰3-腰4水平存在一段时间的椎间盘炎迹象。最终，发现了革兰氏阳性链球菌感染，她接受了13周的抗生素治疗。6个月后她症状消失。一名57岁男性因双侧鹰嘴滑囊炎和脓毒症入住重症监护病房。金黄色葡萄球菌引起的感染性心内膜炎被认为是脓毒症的病因，该患者接受了手术干预和抗生素治疗。由于脓毒症持续存在，进行了不同的计算机断层扫描（CT），一个半月后诊断出广泛的椎间盘炎并伴有脓肿形成，随后接受了手术治疗。延迟诊断椎间盘炎是常见情况而非例外。对于任何有局限性背痛的患者都应考虑该诊断，尤其是伴有发热、血沉增快以及存在高龄、糖尿病、免疫抑制和/或类风湿关节炎等危险因素时。
