Zhai K, Wang L, Wu AF, Qian Y, Huang WM. Pregnancy and lactation-associated osteoporosis with pyogenic spondylitis: A case report. World J Clin Cases 2023; 11(17): 4187-4193 [PMID: 37388803 DOI: 10.12998/wjcc.v11.i17.4187]
Corresponding Author of This Article
Wei-Min Huang, MD, Associate Professor, Neurosurgeon, Department of Orthopedics, 960 Hospital of PLA, No. 25 Shifan Road, Jinan 250031, Shandong Province, China. ever_23@163.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 16, 2023; 11(17): 4187-4193 Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4187
Pregnancy and lactation-associated osteoporosis with pyogenic spondylitis: A case report
Kai Zhai, Lei Wang, Ai-Fang Wu, Ying Qian, Wei-Min Huang
Kai Zhai, Lei Wang, Wei-Min Huang, Department of Orthopedics, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
Ai-Fang Wu, Department of Obstetrics, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
Ying Qian, Department of Endocrinology, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
Author contributions: Zhai K is responsible for writing the manuscript; Wang L followed up the patients; Wu AF and Qian Y performed the research; Huang WM provided this idea and case, and reviewed the manuscript; and all authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Min Huang, MD, Associate Professor, Neurosurgeon, Department of Orthopedics, 960 Hospital of PLA, No. 25 Shifan Road, Jinan 250031, Shandong Province, China. ever_23@163.com
Received: April 12, 2023 Peer-review started: April 12, 2023 First decision: April 26, 2023 Revised: May 4, 2023 Accepted: May 22, 2023 Article in press: May 22, 2023 Published online: June 16, 2023 Processing time: 60 Days and 20.3 Hours
Abstract
BACKGROUND
This case report presents a patient with pyogenic spondylitis (PS) associated with lactation-related osteoporosis during pregnancy. The 34-year-old female patient experienced low back pain for one month, beginning one month postpartum, with no history of trauma or fever. Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of -2.45, leading to a diagnosis of pregnancy and lactation-associated osteoporosis (PLO). The patient was advised to cease breastfeeding and take oral calcium and active vitamin D. Despite these interventions, her symptoms worsened, and she had difficulty walking one week later, prompting her to revisit our hospital.
CASE SUMMARY
Lumbar magnetic resonance imaging (MRI) scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space, while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc, suggesting a lumbar infection. A needle biopsy was performed for bacterial culture and pathological examination, culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS. Following treatment with anti-osteoporotic medications and antibiotics, the patient’s pain gradually subsided, and she returned to normal life within five months. PLO is a rare condition that has garnered increasing attention in recent years. Spinal infections during lactation in pregnancy are also relatively uncommon.
CONCLUSION
Both conditions primarily manifest as low back pain but require distinct treatments. In clinical practice, when diagnosing patients with pregnancy and lactation-associated osteoporosis, the possibility of spinal infection should be considered. A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.
Core Tip: This study described a special clinical condition of pregnancy and lactation-associated osteoporosis with pyogenic spondylitis. Both diseases present mainly as low back pain but are treated differently. The current study helps increase the awareness of this particular disease and reduce the clinical underdiagnosis rate.
