[A case of transverse myelopathy caused by pyogenic vertebral osteomyelitis having extended from a pedal ulcer].

A 64-year-old man who had suffered from diabetes mellitus and a recurrent intractable ulcer of the foot developed subacute transverse myelopathy with severe inflammatory reactions. Magnetic resonance imaging (MRI) revealed destructive lesions in both upper thoracic and lumbar spines. In plain X-ray film, although intervertebral spaces of the lumbar spines were apparently normal on the supine position, they became narrow spaces on the sitting position. The aspiration biopsy from the intervertebral spaces of the lumbar spines showed non-specific necrotic tissues. These findings suggested that the destruction of the intervertebral disks also occurred simultaneously. According to the clinical course and radiological studies, we diagnosed this patient as pyogenic osteomyelitis, and performed the antibiotics therapy. Although he showed no change in his signs and symptoms due to transverse myelopathy, radiological studies exhibited an improvement of both the lumbar and thoracic lesions. In addition, MRI studies in the lumbar lesions revealed low intensity signals on both T1 and T2 weighted images before the antibiotics therapy. It was suggested that lumbar lesions were older than the thoracic lesions. Serial studies including bone X-ray film and MRI were not only useful for the diagnosis of pyogenic osteomyelitis but also for an evaluation of the lesions.