Soda T, Ogura K, Ishitoya S, Niibayashi H, Yoshida O
Department of Urology, Rakuwa-kai Otowa Hospital, Kyoto, Japan.
Int J Urol. 1996 Sep;3(5):402-4; discussion 405. doi: 10.1111/j.1442-2042.1996.tb00564.x.
A case of pyogenic vertebral osteomyelitis after acute bacterial prostatitis in a 78-year-old man is reported. The rarity and subtle clinical presentation of this condition, and the delayed appearance of radiologic signs of progression to destructive osteomyelitis, contributed to a significant delay in diagnosis. An arterial blood culture positive for bacterial growth during the episode of acute prostatitis suggested that bacteremia might result from hematogenous spread of the infection to the vertebral column via the venous system. Since intensive antimicrobial therapy proved ineffective, debridement of the first and second lumbar vertebral bodies, and anterior spinal fusion from the twelfth thoracic to the third lumbar vertebrae were performed. The patient's high fever and severe lumbago subsided immediately after the surgery. The possibility of development to pyogenic vertebral osteomyelitis should be kept in mind when treating a serious genitourinary tract infection.
报道了一例78岁男性在急性细菌性前列腺炎后发生化脓性脊椎骨髓炎的病例。这种疾病的罕见性和微妙的临床表现，以及进展为破坏性骨髓炎的放射学征象出现延迟，导致诊断显著延迟。急性前列腺炎发作期间动脉血培养细菌生长阳性提示菌血症可能是感染通过静脉系统血行播散至脊柱所致。由于强化抗菌治疗无效，遂对第一和第二腰椎椎体进行清创，并进行了从第十二胸椎至第三腰椎的前路脊柱融合术。术后患者的高热和严重腰痛立即消退。在治疗严重的泌尿生殖道感染时，应考虑到发展为化脓性脊椎骨髓炎的可能性。
