Lumbar facet joint septic arthritis presenting atypically as acute abdomen - A case report and review of the literature

Aysha Rajeev; Nameer Choudhry; Mazharuddin Shaikh; Mike Newby

doi:10.1016/j.ijscr.2016.07.001

Lumbar facet joint septic arthritis presenting atypically as acute abdomen - A case report and review of the literature

Int J Surg Case Rep. 2016:25:243-5. doi: 10.1016/j.ijscr.2016.07.001. Epub 2016 Jul 5.

Authors

Aysha Rajeev¹, Nameer Choudhry², Mazharuddin Shaikh³, Mike Newby⁴

Affiliations

¹ Associate Specialist in Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, NE9 6SX, UK. Electronic address: asrajeev18@gmail.com.
² Foundation Doctor in Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, NE9 6SX, UK.
³ Junior Clinical Fellow in Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, NE9 6SX, UK.
⁴ Consultant in Radiology, Queen Elizabeth Hospital, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, NE9 6SX, UK.

Abstract

Introduction: Septic arthritis of the lumbar facet joints is uncommon. The clinical presentation is unusual and patients usually presents with acute back pain or with signs and symptoms mimicking acute abdomen.

Presentation of case: A 52year old man was admitted to the surgical ward with acute onset of abdominal pain and a provisional diagnosis of acute pyelonephritis. After the initial inconclusive investigations, magnetic resonance imaging was highly suggestive of lumbar facet joint septic arthritis. He was treated with intravenous antibiotics with complete resolution of infection.

Discussion: The diagnosis of septic arthritis of facet joint is becoming more common with MRI scans. The clinical signs and symptoms are usually difficult to differentiate from acute spondylodiscitis. The commonest organism isolated is Staphylococcus aureus. A prompt and early diagnosis and treatment help to eradicate infection and prevent complications.

Conclusion: The atypical presentation of facet joint septic arthritis is one of the reasons why early diagnosis is elusive. Definitive diagnoses with MRI and bacterial culture as well as prolonged antibiotic therapy are recommended in this condition.

Keywords: Acute abdomen; Conservative treatment; Facet joint; Septic arthritis.