Low back pain in a diabetic on chronic haemodialysis: pyogenic spondylodiscitis

BMJ Case Rep. 2014 Apr 30:2014:bcr2014204128. doi: 10.1136/bcr-2014-204128.

Abstract

Spondylodiscitis of the lumbar spine is described in a 67-year-old-man receiving chronic haemodialysis via a central venous catheter for diabetic nephropathy. He also had a forearm arteriovenous fistula created 1 month earlier. Clinical, MRI and surgical findings are described. The patient died despite spinal surgery and 1 month of antibiotic therapy from suspected pulmonary embolism. Early recognition by MRI or other imaging technique, prompt antibiotic therapy and often surgery are necessary for a successful outcome in this increasingly recognised complication in patients on chronic haemodialysis. Diabetes mellitus may be an added risk factor.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / therapy
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / therapy*
  • Discitis / diagnosis*
  • Discitis / surgery
  • Empyema / diagnosis*
  • Empyema / therapy
  • Fatal Outcome
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Low Back Pain / diagnosis
  • Low Back Pain / etiology
  • Lumbar Vertebrae
  • Magnetic Resonance Imaging / methods
  • Male
  • Postoperative Complications / physiopathology
  • Pulmonary Edema / diagnosis*
  • Pulmonary Edema / therapy
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods*
  • Severity of Illness Index
  • Spinal Fusion / adverse effects
  • Spinal Fusion / methods