title: Spondylodiscitis as a spinal complication of transrectal ultrasound-guided needle biopsy of the prostate.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  To describe the presentation of pyogenic spondylodiscitis as an iatrogenic spinal complication of a transrectal ultrasound-guided needle biopsy of the prostate (TUGNBP), despite prophylactic use of antibiotics, and discuss possible route of infection.
  
  
  BACKGROUND
  Pyogenic spondylodiscitis is a rare complication of TUGNBP. Several similar case reports, have been previously published, including 1 by the authors of this case report; however, in the present case, spondylodiscitis occurred despite prophylactic antibiotic use.
  
  
  METHODS
  A 59-year-old man was admitted to the neurosurgery department, experiencing severe back and bilateral leg pain for 6 weeks. His neurological examination was normal. His medical and surgical histories were unremarkable, except for a TUGNBP performed 2 months ago because of the high serum levels of prostate-specific antigen levels. At the time of the biopsy, he had been given prophylactic oral antibiotic (ciprofloxacin, 500 mg twice a day) for 2 weeks. The day after biopsy, the patient experienced intermittent high fever and fatigue, and a week after biopsy, he complained of progressive back pain.
  
  
  RESULTS
  After 2 weeks, whole-body bone scan with Tc99m-MDP revealed hyperactivity at the level of L4 and L5 vertebral bodies. His contrast-enhanced magnetic resonance image of the lumbar spine showed diffuse contrast enhancement vertebral bodies and intervertebral disc of L4 and L5 along with contrast-enhanced circumferential epidural mass extending from S2 to L3 levels. L4 hemilaminectomy and epidural and intradiscal abscess drainage at the L4-L5 levels were performed. The diagnosis was consistent with acute discitis with Gram (-) bacilli, and microbiological culture was positive for Escherichia coli. He received intravenous and oral antibiotics for 6 weeks.
  
  
  CONCLUSIONS
  Acute pyogenic spondylodiscitis should be considered among the major complications of TUGNBP and may occur despite prophylactic antibiotic use.
authors.affiliation: Department of Neurosurgery, Kafkas University, Kars, Turkey.
authors.forename: Miktat
authors.initials: M
authors.lastname: Kaya
authors.forename: Kemal
authors.initials: K
authors.lastname: Kösemehmetoğlu
authors.forename: Can Hakan
authors.initials: CH
authors.lastname: Yildirim
authors.forename: Güneş
authors.initials: G
authors.lastname: Orman
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Çelebi
authors.forename: Erol
authors.initials: E
authors.lastname: Taşdemiroğlu
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D002908:Chronic Disease; D015299:Discitis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007049:Iatrogenic Disease; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011472:Prostatitis / Q000473:pathology; D014463:Ultrasonography