Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1402
Peer-review started: October 20, 2020
First decision: December 13, 2020
Revised: December 27, 2020
Accepted: January 12, 2021
Article in press: January 12, 2021
Published online: February 26, 2021
Pyogenic infectious spondylitis (PIS) is a rare condition, with an incidence between 0.2 and 2 cases per 100000 per annum. It’s most common symptom—back or neck pain—occurs in more than 90% of cases. Herein, we reported a case of thoracic PIS accompanied by pneumothorax in a 65-year-old male patient.
A 65-year-old man presented with right chest pain and dyspnea. The initial erect posteroanterior chest radiography revealed pneumothorax, which was further evaluated by chest computed tomography, revealing pleural effusion in the right lung and a paravertebral abscess with bony destruction of vertebral body. Based on magnetic resonance imaging, the patient was diagnosed with thoracic infectious spondylitis with an anterior paravertebral abscess. He was prescribed antibiotics and underwent neurosurgery due to aggravated symptoms and neurologic deficit. Tissue examination revealed that the cause of pleural effusion and pneumothorax was Staphylococcus aureus infection contiguously spread to lung pleura. After several surgical treatments with intravenous antibiotic therapy for two months and transition to oral antibiotics (rifampin 600 mg qd and ciprofloxacin 500 mg bid), the patient received physical therapy to recover balance. One month after discharge, the patient had no chest pain or dyspnea, and exhibited no elevation in inflammatory markers or new thoracic lesions.
To our knowledge, this is the very first report of a case of thoracic PIS with pneumothorax.
Core Tip: Back or neck pain is the most common symptom in over 90% of pyogenic infectious spondylitis (PIS) cases. Anatomically, abscesses occur most often in the spine posterior region because lesions are more likely to develop in larger epidural spaces that contain infection-prone fat. However, in the case presented herein, the spinal abscess initially found in the anterior area of the T8–9 disc and anterior epidural space, spreading contiguously to the lung pleura and causing pleural effusion and pneumothorax. This difference in abscess location may explain the PIS presentation with nonspecific symptoms, such as chest pain and dyspnea.