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Citrobacter koseri osteomyelitis/discitis
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Affiliation: Uniformed Services University
ABSTRACT
Diagnosis: Citrobacter koseri osteomyelitis/discitis History: 52 y/o AA male recently deployed soldier who was medically evacuated due to chronic back pain that interfered with his duties as a truckdriver. While being evaluated stateside his pain worsened and he developed altered mental status, prompting a lumbar puncture which revealed signs consistent with a potential infection. An MRI was then obtained for further evalutaion. Findings: -Plain radiograph one week later showed decreased disk space between T10-T11 -On fat-suppressed MRI (STIR and FSE T2-weighted with fat sat MRI), high-signal -ntensity mass anterior to thoracic vertebrae, high signal intensity in the disc space and in the thoracic vertebrae at this level are consistent with infection. These areas enhance after contrast on the contrast-enhanced fat-saturated T1-weighted MR images. Ddx: 1. Discitis/osteomyelitis 2. Pott's Disease 3. DJD 4. Metastatic cancer Dxhow: CT guided needle biopsy Exam: Back: Mild tenderness to palpation over lower thoracic/upper lumbar spine. CSF: LP opening pressure: 18 cm H2O, wbc=32,rbc=2, glc=53, prtn=92 76%lymphs. Gram stain: pmns present. no organisms. CBC: 5.68>10.6/31.6<443 CMP: 140/4.4/99/29/11/0.5<95, Ca 9.6, PO4 4.8, Mg 1.6 No MeSH data available. |
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MPX2046_synpic42117: T10-T11 disc space abnormality and associated soft tissue inflammatory mass (low signal intensity) |
View Article: MedPix Image - MedPix Case
Affiliation: Uniformed Services University
Diagnosis: Citrobacter koseri osteomyelitis/discitis
History: 52 y/o AA male recently deployed soldier who was medically evacuated due to chronic back pain that interfered with his duties as a truckdriver. While being evaluated stateside his pain worsened and he developed altered mental status, prompting a lumbar puncture which revealed signs consistent with a potential infection. An MRI was then obtained for further evalutaion.
Findings: -Plain radiograph one week later showed decreased disk space between T10-T11 -On fat-suppressed MRI (STIR and FSE T2-weighted with fat sat MRI), high-signal -ntensity mass anterior to thoracic vertebrae, high signal intensity in the disc space and in the thoracic vertebrae at this level are consistent with infection. These areas enhance after contrast on the contrast-enhanced fat-saturated T1-weighted MR images.
Ddx: 1. Discitis/osteomyelitis 2. Pott's Disease 3. DJD 4. Metastatic cancer
Dxhow: CT guided needle biopsy
Exam: Back: Mild tenderness to palpation over lower thoracic/upper lumbar spine. CSF: LP opening pressure: 18 cm H2O, wbc=32,rbc=2, glc=53, prtn=92 76%lymphs. Gram stain: pmns present. no organisms. CBC: 5.68>10.6/31.6<443 CMP: 140/4.4/99/29/11/0.5<95, Ca 9.6, PO4 4.8, Mg 1.6
No MeSH data available.
