Introduction: Infectious spondylitis can be caused by various causes. If appropriate treatment is not performed, complications such as spinal cord injury may occur, so early diagnosis and treatment are needed. In this case report, we will present the case of delayed diagnosis of infectious spondylitis in a patient who was admitted to ICU due to hematemesis and melena.
Case Report: A 66-year-old man with a history of PTSD who underwent orthopedic surgery due to fractures of both tibia four years ago was hospitalized for internal medicine through an emergency room due to hematemesis and melena. About 100mL of hematemesis occurred one week before admission. Two days before and on the day of admission, melena appeared and he came to the emergency room. The patient hit his back during exercise a month ago, and there was no pain afterwards, but the amount of food decreased as the appetite dropped off. Cough, sputum and night sweat were reported 2 weeks before admission and 5kg body weight decreased in one month. Severe anemia was detected in the intensive care unit. Endoscopy was performed to check for gastrointestinal bleeding, and a gastric ulcer with hemorrhage was found. Therefore, epinephrine injection was performed and successful hemostasis was achieved. The pleural effusion was also confirmed and the drain tube was inserted and the antibiotic treatment started. Two days later, the patient was stable and moved to the general ward. On the 4th day of hospitalization, he complained of back pain. At that time, he was able to walk in the ward, so the patient refused further examination for the symptoms. On the 7th day of hospitalization, he complained of severe back pain and weakness in his legs. Therefore, the neurologist examined the patient and conducted whole spine MRI to figure out the cause of weakness. MRI revealed a pathologic fracture of T10 and T11, and an epidural mass compressing the spinal cord.(Fig.1) Therefore, steroid pulse therapy was performed to decompress the spinal cord. Bone biopsy and culture were performed to confirm metastatic cancer or infectious spondylitis, but no specific results were found. The weakness of lower legs gradually progressed to complete paralysis on the 14th day of hospitalization, and decompression surgery was performed. However, the paralysis did not improve, and on the 18th day of hospitalization, the patient was transferred to the rehabilitation department. The state of spinal cord injury was identified as NLI T10, ASIA A. Rehabilitation program was performed, but there was no recovery of motor and sensory function of the lower legs at all.
Conclusion: There was a life-threatening medical problem for the patient, and in the process of resolving it, the appropriate evaluation of the suspected infectious spondylitis was delayed. Thus the patient missed the opportunity for early treatment, and the patient became irreversible and complete paraplegia due to spinal cord injury caused by infectious spondylitis. |
