What's the Diagnosis? By Dr. Loran Hatch
Wed, 12/11/2019 - 10:40am
Editor:
A 30 yo M presents to the ED complaining of atraumatic lower back pain x 2 days. His pain radiates to his b/l lower extremities. He reports a history of IVDU and labs reveal an elevated ESR and CRP. MRI L spine is obtained and shown below. What's the diagnosis? (scroll down for answer)
Answer: Osteomyelitis/Discitis w/ Epidural Abscess
- Bacteria spreads to the epidural space via contiguous or hematogenous spread
- Risk factors: DM, alcoholism, IVDU, immunosuppression, local/systemic infection (soft tissue infection, osteomyelitis, UTI, endocarditis), spinal intervention (surgery, epidural analgesia)
- Causes injury to spinal cord by direct compression or vascular occlusion due to septic thrombophlebitis
- Signs/symptoms
- Stage 1-back pain at level of affected spine
- Stage 2- radicular pain
- Stage 3- motor weakness, sensory defecit, bladder/bowel dysfunction
- Stage 4- paralysis
- Workup
- CBC, ESR, CRP, blood cultures
- MRI with and without contrast is imaging modality of choice
- Treatment
- Broad spectrum antibiotics (vanco/cefepime), narrow based on cultures; duration up to 6 weeks for osteomyelitis
- Decompressive laminectomy and debridement
References:
Darouiche RO. Spinal Epidural Abscess. N Engl J Med. Nov 2006; 355:2012-2020