Salaouatchi Tayeb M, Nechita Mariana I, Bossu Nicolas, Collart Frédéric, Mesquita Maria do Carmo F
Nephrology-Dialysis Clinic, Internal Medicine Department, Centre Hospitalo-Universitaire CHU Brugmann, Nephrology-Dialysis, Brussels, Belgium.
Radiology Department, Centre Hospitalo-Universitaire CHU Brugmann, Brussels, Belgium.
Hemodial Int. 2020 Oct 8. doi: 10.1111/hdi.12884.
Infectious spondylodiscitis (IS) is defined as the pathogenic invasion of the vertebrae and intervertebral disks. It is a serious condition that can lead to many complications such as chronic pain, permanent neurological deficits, and even death. Vertebral surgical procedures, invasive urinary tract manipulations, and central line-associated bloodstream infection are the primary methods by which microorganisms reach the vertebrae and intervertebral disks. Hemodialysis (HD) patients are regularly exposed to bloodstream infections due to long-term catheter utilization or repeated vascular puncturing in patients with arteriovenous fistula. Due to the high risk of blood stream infections, HD patients have a higher risk of developing IS. Despite advanced diagnostic methods, diagnosis of spondylodiscitis is often delayed due to insidious and nonspecific symptoms, allowing dissemination of the infection, which explains the high level of mortality due to spondylodiscitis in HD patients. The infectious process typically occurs in the thoracic or lumbar region, although cervical IS does occur. We herein report the case of a 67-year-old man on HD who developed infectious cervical spondylodiscitis. The diagnosis was established a few days after symptom onset, but the issue was unfortunately fatal despite a well-conducted antibiotic treatment.
感染性脊椎椎间盘炎（IS）被定义为病原体对椎体和椎间盘的侵袭。它是一种严重的病症，可导致许多并发症，如慢性疼痛、永久性神经功能缺损，甚至死亡。椎体外科手术、侵入性泌尿道操作以及中心静脉导管相关血流感染是微生物抵达椎体和椎间盘的主要途径。血液透析（HD）患者由于长期使用导管或动静脉瘘患者反复进行血管穿刺，经常暴露于血流感染风险中。由于血流感染风险高，HD患者发生IS的风险更高。尽管有先进的诊断方法，但由于症状隐匿且不具特异性，脊椎椎间盘炎的诊断往往延迟，从而导致感染扩散，这也解释了HD患者因脊椎椎间盘炎导致的高死亡率。感染过程通常发生在胸段或腰段，不过颈椎IS确实也会发生。我们在此报告一例67岁接受血液透析的男性患者发生感染性颈椎脊椎椎间盘炎的病例。症状出现几天后确诊，但尽管进行了恰当的抗生素治疗，不幸的是该病例仍为致命结局。
