title: Confusion as the presenting manifestation of vertebral osteomyelitis: a case report.
abstract: A 44-year-old patient presented with increasing confusion. He was first diagnosed as having intermittent pressure hydrocephalus but a further evaluation showed CSF pleocytosis and hypoglycorrhachia. Five weeks later, his physical examination was unrevealing. Nuclear imaging techniques were conflicting, with negative gallium- and indium-labelled white blood cells scans but a Tc scan pointing towards a vertebral infection. A well-demarcated lesion in the T9 vertebral body, demonstrated by CT scan, confirmed the diagnosis of vertebral osteomyelitis. Although we were unable to recover the causative organism, antibiotic treatment for presumed staphylococcal osteomyelitis resulted in full recovery. This case indicates that vertebral osteomyelitis may cause significant meningeal inflammation even in the absence of epidural or subdural abscess. We recommend that in patients with meningitis without a clear etiology vertebral osteomyelitis should be considered and pursued with CT scannings of the vertebrae, a procedure that can yield positive findings even when other scanning modalities are negative.
authors.affiliation: Pediatric Neurology Unit, Beilinson Medical Center, Petah Tikva, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Shuper
authors.forename: S
authors.initials: S
authors.lastname: Derossett
authors.forename: O
authors.initials: O
authors.lastname: Hurko
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology / Q000382:microbiology; D002908:Chronic Disease; D003221:Confusion / Q000209:etiology*; D003937:Diagnosis, Differential; D004164:Diphosphonates; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D010019:Osteomyelitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013122:Spinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D013667:Technetium; D017556:Technetium Compounds; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D004164:Diphosphonates; D017556:Technetium Compounds; D013667:Technetium; C029045:technetium Tc 99m diphosphonate