Atypical presentation of osteomyelitis, discitis, epidural, and iliopsoas abscess in diffuse idiopathic skeletal hyperostosis (DISH) syndrome.

Abstract:

:Spine infections are infrequent but important sources of back pain, posing significant risk of neurological sequelae. Risk factors include diabetes, recent trauma or instrumentation, and infection. Pathogens include Staphylococcus aureus and beta-hemolytic Streptococcus. A 67-yr-old man presented with lower back and hip pain of 2-mo duration without fever. Initial treatment and work-up revealed diffuse idiopathic skeletal hyperostosis. The patient did not improve with conservative care, and neurologic decline was recognized. Magnetic resonance imaging identified osteomyelitis, discitis, and epidural abscesses at the L4-L5 levels. Escherichia coli was identified, and antibiotic treatment with CT-guided drainage precluded the need for surgery. Spine infections and iliopsoas abscesses are conditions that can result in serious disability. Awareness of unusual diagnoses and atypical pain presentations in patients with chronic spine pathology, such as diffuse idiopathic skeletal hyperostosis syndrome, is important to recognize early to minimize neurological sequelae.

journal_name

Am J Phys Med Rehabil

authors

Fish DE,Middleton K,Gluzman A

doi

10.1097/PHM.0b013e3181837724

subject

Has Abstract

pub_date

2008-11-01 00:00:00

pages

960-6

issue

11

eissn

0894-9115

issn

1537-7385

journal_volume

87

pub_type

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