Escherichia coli septic arthritis of a lumbar facet joint following urinary tract infection

Abstract

Septic arthritis of a lumbar facet joint is a rare condition. We report the case of a 77-year-old diabetic woman who developed fever and back pain 15 days after she had been diagnosed with a genitourinary infection for which she had received ciprofloxacin. Physical examination showed fever (38°C) and pain on pressure over the lower lumbar spinous vertebral apophyses and over the lower left paraspinal musculature. Investigations showed a white cell count of 8.4×10⁹/l, neutrophils 85.3%, erythrocyte sedimentation rate of 125 mm/h, and C-reactive protein of ≥9 mg/dl. Two blood cultures were both positive for Escherichia coli resistant to ciprofloxacin. There was no growth of pathogens from the urine cultures. Scintigraphy with gallium citrate Ga⁶⁷ showed vertical lower lumbar (L4-L5) radionuclide uptake lateralized to the left. Magnetic resonance imaging of the lumbar spine demonstrated signal changes and alteration of the structure at the left interapophyseal L4-L5 joint, an adjacent small collection of 1cm in diameter, and infiltration of the surrounding soft tissues, which extended to the epidural area, left conjunction hole, and paraspinal muscles. The patient was treated with intravenous cefotaxime and gentamicin and bed rest for 21 days, and recovered. This is the first report of interapophyseal arthritis caused by E. coli.

Lumbar facet joint septic arthritis presenting atypically as acute abdomen – A case report and review of the literature

“…Herrero et al reported a case of E . coli as a causative organism for septic arthritis of lumbar facet joint following a urinary tract infection [17] . Blood cultures are usually positive in 50% of cases [11] .…”

Calcium Pyrophosphate Deposition Disease Involving a Lumbar Facet Joint Following Urinary Tract Infection

“…However, spinal MRI has facilitated the diagnosis of FJA regardless of a septic or non-septic condition. The most common cause of FJA is bacterial hematogenous dissemination from a distant focus of infection, such as acute pyelonephritis (4). Non-septic FJA has been reported to occur due to cartilage damage associated with osteoarthritis and crystal-induced arthritis as CPPD disease.…”

Catheter-based Minimally Invasive Evacuation of Extensive Spinal Epidural Abscess: A Technical Report

“…Pyogenic facet joint (PFJ) is found in 4% of all hematogenous pyogenic infections of the spine and is associated with concurrent extraspinal infection, diabetes mellitus, liver disease, end-stage renal disease, morbid obesity, intravenous drug abuse, alcohol abuse, and chronic steroid use [6, 10]. Other etiologies reported are infective endocarditis [2], acupuncture treatment [1], urinary tract infection [4], and facet injections [5, 7]. Patients commonly present with acute onset of back pain, radiculopathy, fever or paresis.…”

“…Associated inflammatory changes in the epidural space or adjacent paraspinal muscles can be distinguished with gadolinium-enhanced T1-weighted MRI. Gallium-67 scintigraphy can be used when MRI is contraindicated and has good sensibility and sensitivity [4].…”