title: Unilateral septic arthritis of a lumbar facet joint secondary to acupuncture treatment--a case report.
abstract: This report describes a case of septic arthritis of the lumbar facet joint probably as a result of acupuncture treatment. A 48 year old man with a long history of back pain presented with a two week history of increasing pain following a third session of acupuncture. Examination revealed tenderness in the right lumbosacral area and laboratory investigations revealed raised inflammatory markers with negative blood cultures. A bone scan and MRI scan showed evidence of septic arthritis of the right L5/S1 facet joint. An x ray computed tomography guided biopsy was carried out which isolated staphylococcus aureus. The patient was initially treated with intravenous antibiotics. A repeat MRI scan demonstrated persistent septic arthritis with adjacent early abscess formation. Surgical debridement of the facet joint was therefore performed. The patient had resolution of his symptoms and the inflammatory markers returned to normal. He regained a full range of movement of the lumbar spine. Very few cases have been reported of lumbar facet joint septic arthritis and this condition is rare in association with acupuncture treatment. A high index of suspicion needs to be maintained and if conservative management fails then debridement can result in an acceptable outcome.
authors.affiliation: Centre for Spinal Studies and Surgery, University Hospital, Nottingham,UK.
authors.forename: Sachin
authors.initials: S
authors.lastname: Daivajna
authors.forename: Alwyn
authors.initials: A
authors.lastname: Jones
authors.forename: Michael
authors.initials: M
authors.lastname: O'Malley
authors.forename: Hossein
authors.initials: H
authors.lastname: Mehdian
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects* / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D017116:Low Back Pain / Q000382:microbiology; D008159:Lumbar Vertebrae / Q000382:microbiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000382:microbiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents