title: Unusual case of pyogenic spondylodiscitis, vertebral osteomyelitis and bilateral psoas abscesses after acupuncture: diagnosis and treatment with interventional management.
abstract: BACKGROUND
  We report, for the first time, a case of pyogenic spondylodiscitis combined with vertebral osteomyelitis and bilateral psoas abscesses after acupuncture.
  
  
  METHODS
  A 60-year-old man was diagnosed with rectal cancer, and radical rectectomy and permanent colostomy were carried out. However, 3 years after the surgery the patient complained of pain in the lower back, and the symptoms worsened after seven sessions of acupuncture. Technetium 99m-labelled methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy (BS) revealed abnormal uptake of (99m)Tc-MDP in the L4 and L5 vertebrae. He was admitted to our hospital because of suspected bone metastases from rectal cancer. He was diagnosed with infection based on a history of acupuncture and the findings of enhanced MRI and CT. Percutaneous lumbar discectomy (PLD), external drainage and irrigation using antibiotics were carried out to treat the L4-5 disc. Pathological analyses and bacterial culture of the resected disc confirmed infection with group C streptococcus. Postoperative antibiotic treatment resulted in significant pain relief on the third day and gradual complete relief. Considerable improvement was seen on CT and MRI at follow-up.
  
  
  CONCLUSIONS
  We consider it highly likely that this patient's infection was caused by acupuncture. In patients with malignancy, abnormal uptake of (99m)Tc-MDP in BS may signify bone metastasis but can also be observed in bone infections. PLD can be used to resect diseased discs to relieve pain quickly and to prevent herniation of lumbar discs. After PLD, external drainage can be employed for abscess drainage, decompression and perfusion of antibiotics. PLD may serve as an alternative to open surgery for pyogenic spondylodiscitis.
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Chengjian
authors: C
authors: He
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Tao
authors: T
authors: Wang
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Yifeng
authors: Y
authors: Gu
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Qinghua
authors: Q
authors: Tian
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Bi
authors: B
authors: Zhou
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Chungen
authors: C
authors: Wu
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D015299:Discitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011859:Radiography; D014055:Tomography, Emission-Computed
keywords: INFECTIOUS DISEASES; PAIN MANAGEMENT