Spinal epidural abscess with discitis-osteomyelitis and facet joint septic arthritis
A 70 year old male, without immunosuppression, presented with severe thoracic back pain and fulminant septicaemia.
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T1-weighted post-gadolinium sagittal MRI of full spine on admission. A pan-regional (i.e. cervico-thoraco-lumbo-sacral [CTLS]) spinal epidural abscess (SEA) is demonstrated. Focal SEA distort the thecal sac and cause mild canal stenosis but without cord signal change. Discitis with vertebral body osetomyelitis is present at C5/C6, T4/T5, T8/T9; discitis alone at L3/L4 and L5/S1; and left L5/S1 facet joint septic arthritis.
CT and MRI revealed a total CTLS SEA associated with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis. Blood cultures grew Staph. aureus sensitive to flucloxacillin and rifampicin.
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