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Spondylodiscitis: a rare complication following percutaneous nephrostomy

Spondylodiscitis: a rare complication following percutaneous nephrostomy

In press - Corrected proof

Article Type: CASE REPORT

DOI:10.5301/uro.5000204

Authors

Francesco Chiancone, Maurizio Fedelini, Clemente Meccariello, Luigi Pucci, Marco Fabiano, Paolo Fedelini

Abstract

Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique. After 1 week, the patient experienced a severe pain at the lumbar tract of the vertebral column associated with a moderate abdominal pain and septic fever. A magnetic resonance imaging (MRI) of the lumbar spine showed widespread impregnation of the upper portion of L3 and the lower portion of L2 compressing the spinal roots as well as the ileopsoas muscle such as a spondylodiscitis. Liquor culture showed an increase of liquor immunoglobulin G, total liquor protein and was positive for Extended-spectrum beta-lactamases (ESBL) - producing Escherichia coli. After the antibiotic therapy, the spondylodiscitis resolves without important sequelae. In the present case report, we describe a very rare complication of percutaneous nephrostomy tube placement, despite of the prophylactic antibiotic therapy according to the most recent guidelines. Predisposing factors to spondylodiscitis include the very young and elderly, the immunosuppressed, diabetic individuals and a general debilitating disease such as renal failure. This case suggests the importance of remembering spondylodiscitis when septic fever and back pain occurs following the placement of a percutaneous nephrostomy in a septic patient.

Article History

Disclosures

Financial support: The authors received no financial support for the research.
Conflict of interest: The authors declare that there are no conflicts of interest.

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Authors

Affiliations

  • Urology Unit, AORN A. Cardarelli, Naples - Italy

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