Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3542
Peer-review started: May 27, 2020
First decision: June 15, 2020
Revised: June 26, 2020
Accepted: August 6, 2020
Article in press: August 6, 2020
Published online: August 26, 2020
Processing time: 90 Days and 9.6 Hours
Urinary tract infection (UTI) is one of the most common bacterial infections. Acute pyelonephritis or upper urinary tract infection is often accompanied by bacteremia; however, bacteremia resolves in most cases without complication. Rarely, complications due to bacteremia occur. One of these is osteomyelitis. It mainly affects the lumbar vertebral bodies, and rarely affects other site.
An 80-year-old woman presented to the hospital with a two-month history of pain in both legs. Two months ago, she was admitted to the hospital for fever, flank pain, and urinary frequency and was diagnosed with bacteremic UTI. During hospitalization, she complained of pain in both legs; however, the pain resolved shortly after, and no abnormalities were observed on physical examination. Therefore, she was placed on 2-wk antibiotic therapy for UTI without further evaluation for leg pain. However, pain recurred after discharge and persisted; therefore, an imaging test was performed. Bone scan and magnetic resonance imaging suggested osseous infection in both femurs, tibiae and patellae. Surgical treatment was performed, and tissue- and bone cultures revealed Escherichia coli, a previously observed pathogen, which demonstrated same antibiotic sensitivities, as noted in previous UTI. She was diagnosed with disseminated osteomyelitis, as a complication of UTI, and was placed on an 8-wk antibiotic therapy.
Indication for osteomyelitis should be high regardless of bone pain at sites other than lumbar spine after or during UTI.
Core tip: Osteomyelitis caused by urinary tract infections rarely occurs, and most cases involve the lumbar vertebral bodies. The involvement of sites other than the lumbar vertebrae has only been reported in a few cases. This study presents a rare case of disseminated osteomyelitis (involving bilateral femur, knee and tibia) caused by urinary tract infection (UTI) in an immunocompetent patient. Escherichia coli was isolated from both surgically excised tissue and bone cultures, and demonstrated same antibiotic sensitivities, as observed in the previous UTI. This case highlights that osteomyelitis after UTI can occur at sites other than the lumbar spine.