title: Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  Vertebral osteomyelitis, usually presented with back pain and local tenderness, can pose a great challenge of early diagnosis among spinal cord injury (SCI) patients who lost sensation below the injured level. We reported a paraplegic patient who had recurrent febrile episodes after being treated as urinary tract infection initially and was discovered later to have vertebral osteomyelitis.
  
  
  METHODS
  A 41-year-old man, completely paralyzed at the T11 level and with Foley catheterization for 9 years, was re-admitted within 2 weeks for recurrent fever, turbid urine, bacteriuria and bacteremia with Escherichia coli. Spine X-ray and renal, cardiac and abdominal ultrasonography showed no definite lesions related to infection in a previous admission. Intermittently febrile episodes continued despite treatment with antibiotics for 1 week. He had no pressure sores or other wounds. Computerized tomography and magnetic resonance imaging showed lumbosacral osteomyelitis and bilateral paravertebral abscess. The patient underwent debridement of paravertebral tissue. Fever subsided soon after surgery and the patient continued antibiotics and remained free of fever at a 1-year follow-up.
  
  
  CONCLUSIONS
  It can be challenging to diagnose vertebral osteomyelitis below injury levels in SCI patients. Vertebral osteomyelitis should be considered in febrile SCI patients even with known infectious foci, as classic symptoms of osteomyelitis are lacking in this population.
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 7 Chan-Shan South Road, Taipei, Taiwan, ROC.
authors.forename: M-Y
authors.initials: MY
authors.lastname: Hsiao
authors.forename: H-W
authors.initials: HW
authors.lastname: Liang
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis / Q000009:adverse effects; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology* / Q000382:microbiology; D010264:Paraplegia / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D012447:Sacrum / Q000503:physiopathology; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology