title: Spinal osteomyelitis presenting with a life-threatening pleural empyema.
abstract: METHODS
  This case report illustrates a rare presentation of spinal osteomyelitis that initially manifested as a life-threatening pleural empyema leading to misdiagnosis.
  
  
  OBJECTIVE
  A high index of suspicion is required to make the correct diagnosis of spinal osteomyelitis, especially with unusual presentations. Appropriate antibiotic management should be commenced immediately the diagnosis is made.
  
  
  BACKGROUND
  A review of the literature reveals five previous cases of vertebral osteomyelitis associated with pleural effusions. In three of these, the effusions were reactive and sterile. There is only one previous case of a pleural empyema related to primary spinal osteomyelitis. There also is one case report of vertebral osteomyelitis presenting as a mediastinal abscess.
  
  
  METHODS
  A case is presented of a man thought to have bronchogenic carcinoma with a destructive vertebral metastasis who was sent for palliative radiation therapy. A life-threatening pleural effusion subsequently developed, and after additional investigation, he was found to have spinal osteomyelitis with a pleural empyema.
  
  
  RESULTS
  The empyema was drained through an indwelling chest tube, and the patient was administered appropriate antibiotics. He made a complete and uneventful recovery.
  
  
  CONCLUSIONS
  The case illustrates a rare presentation of spinal osteomyelitis. It exemplifies the dictum that if a malignant disease is suspected, every effort has to be made to establish a histologic diagnosis to prevent inappropriate management and the potentially devastating consequences of an incorrect diagnosis. It also high-lights the difficulties in diagnosis of vertebral osteomyelitis with empyema. With correct management, the prognosis is excellent.
authors.affiliation: Department of Orthopaedic, Wythenshawe Hospital, South Manchester, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Jari
authors.forename: A
authors.initials: A
authors.lastname: el-Gamel
authors.forename: T H
authors.initials: TH
authors.lastname: Meadows
authors.forename: C
authors.initials: C
authors.lastname: Campbell
mesh_terms: D000038:Abscess / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis*; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed