Increasing back pain in a young man

Spinal osteomyelitis presenting with a life-threatening pleural empyema

STUDY DESIGN

This case report illustrates a rare presentation of spinal osteomyelitis that initially manifested as a life-threatening pleural empyema leading to misdiagnosis.

OBJECTIVES

A high index of suspicion is required to make the correct diagnosis of spinal osteomyelitis, especially with unusual presentations. Appropriate antibiotic management should be commenced immediately the diagnosis is made.

SUMMARY OF BACKGROUND DATA

A review of the literature reveals five previous cases of vertebral osteomyelitis associated with pleural effusions. In three of these, the effusions were reactive and sterile. There is only one previous case of a pleural empyema related to primary spinal osteomyelitis. There also is one case report of vertebral osteomyelitis presenting as a mediastinal abscess.

METHODS

A case is presented of a man thought to have bronchogenic carcinoma with a destructive vertebral metastasis who was sent for palliative radiation therapy. A life-threatening pleural effusion subsequently developed, and after additional investigation, he was found to have spinal osteomyelitis with a pleural empyema.

RESULTS

The empyema was drained through an indwelling chest tube, and the patient was administered appropriate antibiotics. He made a complete and uneventful recovery.

CONCLUSIONS

The case illustrates a rare presentation of spinal osteomyelitis. It exemplifies the dictum that if a malignant disease is suspected, every effort has to be made to establish a histologic diagnosis to prevent inappropriate management and the potentially devastating consequences of an incorrect diagnosis. It also high-lights the difficulties in diagnosis of vertebral osteomyelitis with empyema. With correct management, the prognosis is excellent.