Document Detail


Bacteremia coexisting with tophaceous gout of the spine mimicking spondylodiscitis: a case report.
MedLine Citation:
PMID:  19139655     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To report a rare case of bacteremia coexisting with spinal gout initially suspected as pyogenic spondylodiscitis. SUMMARY OF BACKGROUND DATA: Gouty spine is a rare disease. It is even rare when coexisting with bacteremia. The presentation as pain, fever, and positive blood culture will make it more difficult to distinguish from spinal infection. METHODS: A 64-year-old woman with type II diabetes mellitus and chronic renal insufficiency was admitted to the emergency department with a fever of 39 degrees C, chills, and back pain. Laboratory studies revealed an elevated white count and neutrophils; her serum glucose level was 279 mg/dL. The C-reactive protein level was 25.55 mg/dL and serum uric acid was in the upper range of normal. Blood cultures revealed Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Urine culture revealed 3 separate gram-negative bacilli. Magnetic resonance imaging of the spine revealed contrast enhancement in the L4-L5 and T5-T9 vertebral bodies. Infective spondylodiscitis of the lumbar and thoracic spine was suspected. RESULTS: Because antibiotic treatment had failed, surgical debridement with diskectomy, partial corpectomy, and allogenous strut graft reconstruction (T8-T9) was performed. During the operation, 600 cc of pleural effusion was drained. Chalky white material was noted at the T8-T9 disc and the adjacent vertebral bodies. Cultures for bacteria, tuberculosis, and fungus were all negative. Histologic examination revealed deposition of eosinophilic crystal-like material, and a diagnosis of tophaceous gout of the spine was established. CONCLUSION: This is, to our knowledge, the first case of bacteremia coexisting with multiple areas of tophaceous gout of the spine. Although uncommon, gouty spine should be added into the differential diagnosis of patients with back pain and bacteremia.
Authors:
Chun-Hao Tsai; Yen-Jen Chen; Horng-Chaung Hsu; Hsien-Te Chen
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Spine     Volume:  34     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-13     Completed Date:  2009-04-09     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E106-9     Citation Subset:  IM    
Affiliation:
Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / therapeutic use
Bacteremia / blood,  complications*,  microbiology*
Debridement
Diabetes Complications / pathology,  physiopathology
Discitis / diagnosis,  microbiology
Diskectomy
Female
Gout / complications*,  pathology*,  physiopathology
Humans
Lumbar Vertebrae / pathology,  surgery
Magnetic Resonance Imaging
Middle Aged
Pleural Effusion / pathology,  physiopathology
Reconstructive Surgical Procedures
Renal Insufficiency, Chronic / complications
Spinal Diseases / complications*,  pathology*,  physiopathology
Thoracic Vertebrae / pathology,  surgery
Treatment Failure
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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