Spondylodiscitis and suspected seronegative spondyloarthropathy
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Online publication date: 2011-06-05
Reumatologia 2011;49(3):208–214
Symptoms of spondylodiscitis may be the same as in the case of seronegative spondyloarthropathies and may require differentiation among these disease entities (Table I). Seronegative spondyloarthropathies are a group of inflammatory diseases with the involvement of joints of the spine and peripheral joints. Among the inflammation of bone and bone marrow, the infectious inflammation of the intervertebral disc accounts for about 2-4% of all cases. The following is a case report of an 18-year-old man who was admitted to hospital with a suspicion of spondyloarthropathy. The patient experienced back pain, tenderness of peripheral joints and fever episodes. After exclusion of spondyloarthropathy, he was ultimately diagnosed with an infectious inflammation of the intervertebral disc. Magnetic resonance imaging enabled the diagnosis (Fig. 1, 2) and the evaluation of the effectiveness of treatment (Fig. 3, 4). Not in every case of infectious intervertebral disc, it is possible to establish an aetiological agent, then in the treatment one should consider potential risk factors for infection and the most common pathogens that cause spondylodiscitis such as Staphylococcus aureus (50%) and Escherichia coli (23%). Lack of clinical improvement after 2 weeks of optimally targeted treatment with antibiotics administered intravenously would be an indication for surgical treatment. In this case, the diagnosis was confirmed by a good therapeutic effect of antibiotics, thus there were no indications for surgical treatment. This case also points out to the need for rapid assessment of the spine by magnetic resonance imaging in patients with inflammatory back pain and systemic symptoms given doubts as to their aetiology and the lack of explanation of their reasons in classical X-ray. As patients with low immunity and chronic diseases and treated with glucocorticoids are more exposed to infectious inflammation of the intervertebral disc, this problem can also occur in patients with rheumatic diseases. Both diagnosis and principles of treatment of spondylodiscitis are important in the rheumatological practice.
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