Журнал клинических случаев

Picked Up by a Wasp? Watch Out the Spine! A Case of Multifocal Pyogenic Spondylodiscitis

Abstract

Geniere Nigrag S, Casazza A, Carnevale L and Ricevuti G

Introduction: spondylodiscitis represents 3-5% of all cases of osteomyelitis. S. aureus is isolated in 50% of cases. Mortality ranges is 0-11%. Disability may occur. Diagnosis is often a challenge. Lumbar spine is preferentially affected with multifocal involvement in 4% cases. Septic shock mortality rate is high (22-76%). Purpose: to describe a case of septic shock due to pyogenic multifocal spondylodiscitis successfully-treated in Intensive Care Unit (ICU). Methods: 63-year-old woman presented in Emergency Department complaining 7 days back pain, weakness and diarrhea. Clinical setting suggested intra-abdominal infection. Rapid hemodynamic derangement required ICU transfer to treat septic shock and multiple organ failure. Cerebrospinal fluid (CSF) analysis showed normal count cells and hyperproteinorachia. Methicillin-sensitive S. aureus (MSSA) was isolated from blood cultures and in a very low charge from CSF. In addiction C. difficile toxin was found. Vertebral spine Magnetic Resonance Imaging showed spondylodiscitis in multiples vertebral bodies and intervertebral disks, paravertebral and Psoas muscles abscesses. Further anamnestic information allowed identification of recent wrist wasp sting (infected by the same MSSA). In ICU, patient underwent C. albicans fungemia and P. aeruginosa sepsis. She was treated with antibiotics and we performed advanced-cardiovascular-support, protective-mechanicalventilation and continuous-venovenous- hemofiltration. Results: after 79 days, patient was transferred to rehabilitation ward and then back home. Conclusions: despite previous delay in sepsis recognition and its underlying cause, early application of intensive support and close adherence to Survival Sepsis Campaign treatment guidelines were critical issues for the survival of this unusual spondylodiscitis case.