초록접수[미리보기]
| 21KF-039 |
Delayed diagnosis of infectious spondylitis after nerve block
Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital,
Gwangju, Korea
Introduction
Delayed diagnosis of infective spondylitis is not uncommon due to various clinical symptom and nonspecific imaging findings.
Case
A 84-year-old female patient was consulted from emergency department. She complained of back pain and fever which were controlled by intravenous paracetamol. Laboratory exam suggested a urinary tract infection. MRI finding was recent compression fracture of third lumbar spine and psoas muscle enhancement with small fluid collection (<1cm) suggesting hematoma or myositis. Nevertheless, spinal infection could not be ruled out because of the recurrent fever episodes accompanied with aggravating back pain. A detailed history taking revealed that she had received spinal nerve block several days ago. When the body temperature rose, severe lumbar paravertebral stroke tenderness was prominent on physical examination. Suspected of infectious spondylitis, we consulted her to the department of infectious disease and empirical antibiotics were administered. The symptoms did not improve, and MRI performed again on the 22nd day of hospitalization showed prominent infectious spondylitis finding. After surgical treatment, she improved and was discharged from the hospital.
Conclusion
Infectious spondylitis may not exhibit a typical MRI finding at early stage and the diagnosis could be delayed if there is accompanying infection or spinal disease. A detailed history taking and physical examination to find clinical clues and red flag sign are of utmost importance for a timely diagnosis.
Delayed diagnosis of infective spondylitis is not uncommon due to various clinical symptom and nonspecific imaging findings.
Case
A 84-year-old female patient was consulted from emergency department. She complained of back pain and fever which were controlled by intravenous paracetamol. Laboratory exam suggested a urinary tract infection. MRI finding was recent compression fracture of third lumbar spine and psoas muscle enhancement with small fluid collection (<1cm) suggesting hematoma or myositis. Nevertheless, spinal infection could not be ruled out because of the recurrent fever episodes accompanied with aggravating back pain. A detailed history taking revealed that she had received spinal nerve block several days ago. When the body temperature rose, severe lumbar paravertebral stroke tenderness was prominent on physical examination. Suspected of infectious spondylitis, we consulted her to the department of infectious disease and empirical antibiotics were administered. The symptoms did not improve, and MRI performed again on the 22nd day of hospitalization showed prominent infectious spondylitis finding. After surgical treatment, she improved and was discharged from the hospital.
Conclusion
Infectious spondylitis may not exhibit a typical MRI finding at early stage and the diagnosis could be delayed if there is accompanying infection or spinal disease. A detailed history taking and physical examination to find clinical clues and red flag sign are of utmost importance for a timely diagnosis.
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