Septic discitis as a cause of intractable back pain: deja vu.To the Editor: I read with interest the article by Patel et al (1) which describes an elderly immunocompromised immunocompromised /im·mu·no·com·pro·mised/ (-kom´pro-mizd) having the immune response attenuated by administration of immunosuppressive drugs, by irradiation, by malnutrition, or by certain disease processes (e.g., cancer). man who developed intractable back pain following cytotoxic curative chemotherapy for non-Hodgkin lymphoma. I agree with the authors that septic discitis is an important, although often overlooked, differential diagnosis of back pain in immuno-compromised individuals following chemotherapy, and should be seriously considered in any situation associated with bacteremia bacteremia: see septicemia. bacteremia Presence of bacteria in the blood. Short-term bacteremia follows dental or surgical procedures, especially if local infection or very high-risk surgery releases bacteria from isolated sites. in these patients. In his practice of anesthesiology and pain management, the author of this letter has encountered a 64-year-old female patient who presented with a 2-month history of intractable back pain of "unknown etiology at presentation," following chemotherapy for advanced stage gynecological gynecological /gy·ne·co·log·i·cal/ (-kah-loj´i-k'l) gynecologic. cancer. The septic discitis in our patient was finally attributed to an infected peripheral venous catheter in the immediate postchemotherapy period (Staphylococcus aureus bacteremia), and the diagnosis was confirmed by magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. of the lumbar spine and fluoroscopically guided fine needle aspiration fine needle aspiration Diagnostics A method of in which a thin or “skinny”–18- to 23-gauge needle is used to suck in cells or tissue bits for diagnoses; the sites selected for FNAs are often guided by radiologists with fluoroscopy, CT, MRI of the lumbar disc space (cultures yielded S aureus). This report also provides one more piece of evidence that in immunocompromised patients, peripheral vascular catheters should be inserted with careful aseptic technique, and removed as soon as they are no longer indicated. Reference 1. Patel P, Olive KE, Krishnan K. Septic discitis: an important cause of back pain. South Med J 2003;96:692-695. Krzysztof M. Kuczkowski, MD Director, Obstetric Anesthesia Assistant Clinical Professor Departments of Anesthesiology and Reproductive Medicine University of California, San Diego UCSD is consistently ranked among the top ten public universities for undergraduate education in the United States by U.S. News & World Report.[3] It is a Public Ivy. [1] For graduate studies, most of UCSD's Ph.D. San Diego, CA |
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