Extract
Despite the proximity of the vertebral bodies and discs to the vascular
structures of the retroperitoneum, the association of spinal osteomyelitis and
aortic infection is a
rare1, easily
overlooked, but potentially lethal condition that requires prompt diagnosis
and aggressive surgical therapy. The pathogens responsible for concurrent
vertebral and aortic lesions include Salmonella species as well as other
gram-negative bacilli, mycobacteria, gram-positive cocci, and
fungi1-3.
A delay in the start of appropriate antimicrobial therapy for infections
involving these anatomic sites could result in bone and joint destruction and
possibly death. We report the case of an elderly immunocompromised patient who
had a mycotic aneurysm caused by Salmonella species. After aneurysmectomy, he
experienced persistent back pain and progressive loss of lower-extremity
neurological function. Further work up disclosed tuberculous lumbar
spondylitis and an epidural abscess in the vicinity of the resected aneurysm.
The case of this patient emphasizes the possibility of coexistent infection in
vulnerable patients. The pitfalls in diagnosis and management are discussed,
to enable clinicians to avoid potentially catastrophic complications. The
patient was informed that data concerning the case would be submitted for
publication.