Araújo Filipe, Ribeiro Célia, Silva Inês, Nero Patrícia, Branco Jaime C
Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal.
Acta Reumatol Port. 2012 Jul-Sep;37(3):260-3.
Spinal infections are rare but potentially life-threatening disorders. A high level of clinical suspicion is necessary for rapid diagnosis and treatment initiation. The treatment combines both antibiotics and surgical intervention in the vast majority of cases. The authors report the case of a 84-year old female patient with a three week history of persistent lumbar back pain radiating to both thighs following a lower respiratory tract infection. She had lumbar spine tenderness but no neurological compromise. Her inflammatory markers were elevated and lumbar spine magnetic resonance imaging revealed L4-L5 spondylodiscitis with spinal epidural abscess. Blood cultures isolated Klebsiella pneumoniae and, since she was neurologically stable, conservative treatment with two-week intravenous gentamicin and eight-week intravenous ceftriaxone was initiated with positive inpatient and outpatient evolution.
脊柱感染虽罕见，但可能危及生命。高度的临床怀疑对于快速诊断和开始治疗至关重要。在绝大多数病例中，治疗需联合使用抗生素和手术干预。作者报告了一例84岁女性患者的病例，该患者在发生下呼吸道感染后持续腰痛三周，疼痛放射至双侧大腿。她有腰椎压痛，但无神经功能损害。其炎症指标升高，腰椎磁共振成像显示L4-L5椎间盘炎伴脊髓硬膜外脓肿。血培养分离出肺炎克雷伯菌，由于她神经功能稳定，开始采用两周静脉注射庆大霉素和八周静脉注射头孢曲松的保守治疗，住院和门诊治疗过程均呈阳性进展。
