Rheumatology, Mater Dei Hospital, L-Imsida, Malta
Rheumatology, Mater Dei Hospital, L-Imsida, Malta.
BMJ Case Rep. 2020 Dec 28;13(12):e238522. doi: 10.1136/bcr-2020-238522.
A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2-3 and L5-S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient's clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.
一位 71 岁男性,因腰背疼痛放射至右侧臀部和大腿,伴下肢无力和全身症状,就诊 3 个月。影像学检查证实 L2-3 和 L5-S1 存在腰骶椎骨关节炎,并伴有右侧腰大肌脓肿,遂行紧急 CT 引导下引流和静脉内抗生素治疗。该患者入院时合并多种并发症,包括多处椎体破坏、硬膜外脓肿形成和深静脉血栓形成的骨髓炎。此外,患者发生严重脓毒症,需要入住重症监护病房。患者经静脉内抗生素治疗后病情逐渐好转,直至可以转至康复中心,在那里接受定期职业和物理治疗。重复影像学检查显示上述病变总体缓解,目前正在脊柱外科医生的门诊随访中。