A 78-year-old patient with a history of hypertension, type 2 diabetes mellitus, osteoporosis, and recurrent nephritic colic that 6 days prior to admission presented with pain in the right renal fossa radiating to the ipsilateral knee, who was treated with ambulatory t
Subsequently, the patient began to present dysthermic sensation with temperature above 38oC, poor general condition, urinary symptoms and glycemic control, due to hospitalization.
Physical examination revealed a marked affectation of general condition, fever, pain in the sacral area with negative bilateral percussion wrist and knees with phlogistic signs.
The laboratory analysis showed mild leukocytosis without left shift (12.100x103/mm3 with N 65%), hyperbilirubinemia of direct predominance (BT: 3.4 mg/dl, BD: 2.7mg/ 215dl/L), alkaline phosphatase
The rest of the analytical did not show significant alterations.
As complementary examinations are performed hemo- and urocultive, puncture and cultures of joint fluid, CT of the abdominal and lumbosacra spine, magnetic resonance of the lumbar spine and gammagraphy with Ga-67/MDP-Tc-99.
Abdominal and lumbosacra CT scans show air densities in the right lumbar and psoas muscles and in the intraspinal and dorsal locations.
Gas is also visualized in the bone channel that could correspond to rupture disc L4-L5.
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Magnetic resonance imaging of the lumbar spine confirmed images with abscesses compatible for the right and right pso muscles, and localized psoas in L4-L5 suggesting epidural abscesses in D12-L4.
An alteration of the signal of the D12 body was observed after administration of gadolinium translated into bone edema compatible with spondylitis and probable spondylodiscitis.
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In the body scan combined with Ga-67/MDP-Tc-99M there is pathological hyperfixation of both tracers in the knees and shoulders suggesting increased inflammatory-infectious process as well as in adjacent soft tissue uptake.
On admission, empirical antibiotic treatment with ciprofloxacin was initiated, subsequently confirming the presence of Escherichia coli with similar antibiogram in microbiology (blood culture, urine and joint fluid).
During the first days of treatment, the patient achieved a slight improvement in symptomatology, with the introduction of antibiotics and antipyretics.
On the 10 day of admission, the fever reappeared and the general condition progressively worsened.
On the 12th day of admission, the patient developed atrial fibrillation with rapid ventricular response and cardiorespiratory arrest unresponsive to resuscitation maneuvers.
The diagnosis was E. coli urinary infection complicated with polyarticular septic arthritis, spondylodyscitis, epidural abscesses, psoas and dorsolumbar muscles.
