title: Diabetic foot complicated by vertebral osteomyelitis and epidural abscess.
abstract: Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement of the foot infection, high fever and lower back pain continued. Bone biopsy and two consecutive blood cultures were positive for Staphylococcus aureus. A spinal magnetic resonance imaging (MRI) was performed, revealing serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Contiguous or other distant focuses of infection were not identified. In this case, diabetic foot could be considered as a primary distant focus for vertebral osteomyelitis. Clinicians should consider vertebral osteomyelitis as a 'possible' diagnosis in patients with type 2 diabetes complicated by foot infection that is associated with fever and lower back pain.
  
  
  CONCLUSIONS
  Vertebral osteomyelitis is increasing in Western countries, especially in patients with type 2 diabetes.The primary focus of infection is the genitourinary tract followed by skin, soft tissue, endocarditis, bursitis, septic arthritis, and intravascular access.Diabetic foot could be a rare primary focus of infection for vertebral osteomyelitis, and, however, vertebral osteomyelitis could be a serious, albeit rare, complication of diabetic foot.Clinicians should keep in mind the many potential complications of diabetic foot ulcerations and consider vertebral osteomyelitis as a "possible" diagnosis in patients with type 2 diabetes and foot ulcers associated with nonspecific symptoms such as lower back pain.Early diagnosis and correct management of vertebral osteomyelitis are crucial to improve clinical outcomes.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Trombetta
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Imbriaco
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rigolon
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mingolla
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Zamboni
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Dal Molin
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Cioccoloni
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Sanga
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Bruti
authors.affiliation: Regional Referral Center for the Treatment of Diabetic Foot , Policlinico Abano Terme, Padova , Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brocco
authors.affiliation: Division of Infectious Disease, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Conti
authors.affiliation: Division of Neurosurgery, Department of Surgery, University and Azienda Ospedaliera Universitaria Integrataof Verona , Verona , Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ravenna
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Perrone
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Stoico
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona , Verona , Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora