Severe back pain a cirrhotic patient : a diagnostic challenge

• Main Authors: Ioana Stănescu, Angelo Bulboacă, Kallo Rita, Gabriela Dogaru, Adriana Bulboacă
• Format: Article
• Language: English
• Published: Romanian Association of Balneology, Editura Balneara 2018-05-01
• Series: Balneo Research Journal
• Subjects: spondilodiscitis; vertebral osteomyelitis; bacteriemia; hepatic cirrhosis
• Online Access: http://bioclima.ro/Balneo173.pdf

Spondylodiscitis is an infection of the intervertebral disc space, involves the vertebrae, causing vertebral osteomyelitis and spread to adjacent epidural space, causing dural, radicular or spinal cord compression. Appears mainly in adult and immunocompromised patients, mainly by haematogenous inoculation from systemic infections with bacteriemia. Patients with hepatic cirrhosis have frequent bacteriemias, produced by increased gut permeability, immune dysfunction and frequent need for invasive procedures. Despite high frequency of blood stream infections, discitis and vestebral osteomyelitis are rarely reported. We present the case of a 53 years old woman, diagnosed with class B Child Pugh cirrhosis, which presents with intense back pain and cauda equina syndrome, without clinical signs of infection. Diagnosis was confirmed by spinal MRI, but very soon after treatment onset, the patient suffered a septic shock with haemodynamic instability, which leads to patient’s death. This case illustrates how an unusual complication of cirrhosis – bacteriemia - could precipitate the unfavorable evolution of the patient by producing a remote septic complication. Persistent back pain in a cirrhotic patient should also raise the hypothesis of an infectious cause, in which early management is essential. Early diagnosis in essential for successful treatment, and good prognosis after long-term antibiotic treatment can be achieved in the majority of patients.