We describe a case of infectious spondylodiscitis of the lumbar spine  complicated by epidural and bilateral psoas abscesses which started with subtle symptoms and a non-specific clinical picture. Diagnosis is based on clinical, laboratory and radiological features. It can be difficult and often delayed due to the rarity of the disease and the high frequency of low back pain in the general population. Our aim is to raise awareness for the possibility of specific low back pain which requires quick and indispensable action from the physician.

BackgroundThe leading causes of death in patients suffering from systemic sclerosis are interstitial lung disease, malignancy and pulmonary arterial hypertension, but several other cardiovascular complications affect their quality of life.ObjectivesOur investigation aimed to examine biomarkers relating to active fibrotic changes in the myocardium and pulmonary vasculature and to find potential correlations with pathological findings detected by exercise stress echocardiography.Methods28 consecutive systemic sclerosis patients attending our outpatient clinic underwent complete physical examination and routine blood tests. At the same day, resting and stress echocardiography were performed with supine bicycle exercise stress, and serum NT-proBNP, galectin-3 and soluble suppression of tumorigenesis-2 (sST-2) levels were measured. Patients with defined cardiological disease (systemic sclerosis-related manifestation or co-morbidity), interstitial lung disease, overt pulmonary hypertension or severe musculoskeletal disorder (active myositis, arthritis and severe lower limb osteoarthrosis) were excluded from the cohort.Results27 female and 1 male patient participated in the study, aged 55,09±13,05 years. Median serum galectin-3 level was 58.57±31.48 ng/ml, in 24 patients, it was found to be elevated (normal range: >22,1 ng/ml, 85.71%). The sST-2 median level was 108,39±44,06 ng/ml, increased in 27 patients (normal range>35 ng/ml, 96,43%). Elevated levels of NT-proBNP were found in 24 patients. On echocardiography performed at rest, normal pulmonary arterial pressure was calculated in all 28 patients, while in the majority of them (in 23 patients), stress-induced pulmonary arterial hypertension (SIPAH) occurred at different grades of bicycle exercise. In those patients, the NT-proBNP level was also significantly higher (161,4± 85 vs 93,5± 61 pg/ml in those without SIPAH, p <0,05). Serum galectin -3 level showed a negative correlation with the peak heart rate measured at the maximal stress (r=0,48, p<0,05), and Tricuspid Annulus Plane Systolic Excursion (TAPSE) was lower at rest and on exertion in all patients whose galectin-3 level was found to be elevated. (p<0,05)ConclusionBiomarkers such as galectin-3 and NP-proBNP provide objective information about the ongoing pathophysiological changes of the myocardium in systemic sclerosis patients. A subset of patients with normal pulmonary arterial pressure at resting echocardiography develops SIPAH. The combination of echocardiographic findings with serum levels of NT-proBNP and galectin-3 may help to identify systemic sclerosis patients with a higher risk of progressive pulmonary arterial or myocardial involvement. Our ongoing project is to follow up these patients with annual examinations.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.