title: Atypical presentation of osteomyelitis, discitis, epidural, and iliopsoas abscess in diffuse idiopathic skeletal hyperostosis (DISH) syndrome.
abstract: Spine infections are infrequent but important sources of back pain, posing significant risk of neurological sequelae. Risk factors include diabetes, recent trauma or instrumentation, and infection. Pathogens include Staphylococcus aureus and beta-hemolytic Streptococcus. A 67-yr-old man presented with lower back and hip pain of 2-mo duration without fever. Initial treatment and work-up revealed diffuse idiopathic skeletal hyperostosis. The patient did not improve with conservative care, and neurologic decline was recognized. Magnetic resonance imaging identified osteomyelitis, discitis, and epidural abscesses at the L4-L5 levels. Escherichia coli was identified, and antibiotic treatment with CT-guided drainage precluded the need for surgery. Spine infections and iliopsoas abscesses are conditions that can result in serious disability. Awareness of unusual diagnoses and atypical pain presentations in patients with chronic spine pathology, such as diffuse idiopathic skeletal hyperostosis syndrome, is important to recognize early to minimize neurological sequelae.
authors.affiliation: Department of Orthopedics, Physical Medicine and Rehabilitation, David Geffen School of Medicine at UCLA, Santa Monica, CA 90404, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Fish
authors.forename: Kimberley
authors.initials: K
authors.lastname: Middleton
authors.forename: Arie
authors.initials: A
authors.lastname: Gluzman
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015299:Discitis / Q000209:etiology / Q000473:pathology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications / Q000000981:diagnostic imaging*; D015378:Imipenem / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000209:etiology / Q000473:pathology; D016659:Psoas Abscess / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D011859:Radiography
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem