Low back pain in a diabetic on chronic haemodialysis: pyogenic spondylodiscitis.
Spondylodiscitis of the lumbar spine is described in a 67-year-old-man receiving chronic haemodialysis via a central venous catheter for diabetic nephropathy. He also had a forearm arteriovenous fistula created 1 month earlier. Clinical, MRI and surgical findings are described. The patient died despite spinal surgery and 1 month of antibiotic therapy from suspected pulmonary embolism. Early recognition by MRI or other imaging technique, prompt antibiotic therapy and often surgery are necessary for a successful outcome in this increasingly recognised complication in patients on chronic haemodialysis. Diabetes mellitus may be an added risk factor.
Department of Medicine, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago.
Kanterpersad
K
Ramcharan
Liane
L
Conyette
Boris
B
Mohammed
Ravi
R
Narine
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000628:therapy*; D015299:Discitis / Q000175:diagnosis* / Q000601:surgery; D004653:Empyema / Q000175:diagnosis* / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods