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Spinal epidural abscess with discitis-osteomyelitis and facet joint septic arthritis

Case contributed by Appukutty Manickam
Diagnosis certain

Presentation

Severe thoracic back pain and fulminant septicemia. No immunosuppression.

Patient Data

Age: 70 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

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 distorts the thecal sac and causes 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.

Case Discussion

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 rifampin. 

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