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Gas in Vertebrae

Published:February 20, 2021DOI:https://doi.org/10.1016/j.amjmed.2020.12.030
      A 91-year-old woman was admitted to our hospital with fever and back pain lasting for 2 days. She reported no throat pain, cough, chest pain, dyspnea, abdominal pain, diarrhea, micturition pain, or arthralgia. She had a history of coronary artery bypass grafting for ischemic heart disease and uncontrolled type 2 diabetes mellitus. Her medications included aspirin, pravastatin, imidapril, sitagliptin, glimepiride, and furosemide. She did not smoke or drink alcohol and used no illicit drugs. Upon examination, the patient appeared unwell. She was somnolent and disoriented, unaware of the time and place. Her temperature was 36.8°C, blood pressure 133/60 mm Hg, pulse 67 beats per minute, and oxygen saturation 97% while breathing ambient air. The lungs were clear, and the heart sounds were normal. The abdomen was soft and flat, and no discomfort was elicited during palpation. There was no tenderness on the spine or costovertebral angles. No swollen joints, rashes, or edema were detected. Her neurological findings were unremarkable. Laboratory tests revealed leukocytosis, an elevated C-reactive protein level of 24.2 mg/dL, and an elevated creatinine level of 1.9 mg/dL. In addition, the patient's hemoglobin A1c level was 8.8%, and her serum glucose level was 392 mg/dL. Urinary testing revealed no pyuria. Subsequent computed tomography of the chest and pelvis revealed intraspinal and paraspinal gas in the spine at the thoracic and lumbar levels (Figure). This finding made us aware of emphysematous vertebral osteomyelitis. Vertebral osteomyelitis and epidural abscess of the thoracic spine were confirmed by magnetic resonance imaging of the spine. Escherichia coli grew in the blood culture. Thus, emphysematous vertebral osteomyelitis due to E. coli complicating epidural abscess was diagnosed. Initial nonsurgical therapy with antibiotics for the causative organism failed to improve this condition, and then surgical drainage was performed on the 15th day of hospitalization. Nonetheless, the patient died due to postoperative complications.
      Figure
      FigureIntraspinal and paraspinal gas of the thoracic spine.
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