Document Type : Case Reports
Al-Kindy Teaching Hospital, Baghdad, Iraq, PO Box 10011
Beaumont Hospital, Dublin, Ireland Royal College of Surgeons in Ireland, Dublin, Ireland
Baghdad Teaching Hospital, Baghdad, Iraq University of Baghdad-College of Medicine, Baghdad, Iraq
Ziauddin university Hospital Clifton Karachi, Pakistan
Background Data: Multiple noncontiguous spontaneous pyogenic spondylodiscitis is rare and has only been explained in the literature by case reports and case series.
Purpose: We present a case report of multiple noncontiguous spontaneous spondylodiscitis caused by E. coli involving the cervical and lumbar spine following a mastectomy for breast cancer. We will explain the difficulties in diagnosis, treatment, and follow-up with the concomitant.
Study Design: A case report and literature review.
Case Report: A middle-aged patient with a history of breast carcinoma underwent surgery. Two weeks after mastectomy, the patient developed severe cervical and lumbar spine pain and a low-grade fever (37.5–38.3 °C). Moreover, neurological examination revealed a right-sided antalgic gait, right-sided weakness, and a positive straight leg raising test. Upon presentation, elevated C-reactive protein (CRP) and white blood cells (WBC) were noted. Magnetic resonance imaging (MRI) showed consistent spondylodiscitis at C5-C6 and L3-L4 levels with stenotic features at L4-L5 levels. Surgical treatment of the lumbar region via posterior spinal instrumentation from L3 to L5 levels and decompression was done with a biopsy. Erythrocyte sedimentation rate (ESR) CRP titers were also performed for the follow-up plan, which showed a reduction in 3, 6, and 12 weeks postoperatively. Conservative treatment of the cervical region was undertaken with a complete cure.
Conclusion: Multiple noncontiguous spondylodiscitis after nonspinal surgery is a relatively rare complication requiring a high suspicion index. Surgery is recommended in case of failure of conservative measures, neurological deficit, or mechanical instability as in this case. Furthermore, both clinical examination and blood tests should be used to assess the treatment outcomes. (2021ESJ246)