Case 183 -- Bilateral Back Pain and Fever

Contributed by Jianzhou Wang, MD, PhD, Wen-Wei Chung, MD, PhD, Shaila Fernandes, MD and William A Pasculle, ScD
Published on line in February 1999


The patient was a 68-year-old woman with a history of polydipsia, polyuria, bilateral back pain and fever who was admitted to a UPMC Hospital with agitation, confusion and delirium. In the Emergency Department, she was found have a glucose of 350 mg/dl and was dehydrated. She also complained of a 30 lb weight loss and right hip pain. During the hospital stay, a radiology work-up revealed a mixed lytic and sclerotic destructive process of the inferior end plate of L1 and superior end plate of L2 associated with bilateral psoas muscle abscesses (Image 01). Multiple CT guided drainage of psoas abscesses was performed, and specimens were sent for microbiological studies. The patient also underwent debridement of vertebral body with bilateral drainage catheters placed. The patient was found to be allergic to penicillin, and was treated initially with combined clindamycin and vancomycin, and then switched to ciprofloxacin based on microbiological studies. The patient initially showed slight improvement, but latter developed rapid progressive heart failure despite aggressive antibiotic therapy, and expired 4 weeks later.



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