A 55 year-old man was admitted for worsening of a chronic low back pain associated with L4-L5 anterolisthesis, despite taking non-steroidal anti-inflammatory drugs for several months. He had a medical history of high blood pressure and obesity (body mass index, 37 kg/m2). He lived in the countryside but had no direct contact with animals except his dog. There were no fever, chills, sweats or weight loss. C reactive protein (CRP) was <2.9 mg/L. Radiographs showed L4-L5 anterolisthesis with endplate erosions and bony sclerosis (figure 1A). On MRI (figure 1B), there was a significant enhancement of L4-L5 vertebral endplates and paravertebral soft tissues. Positron emission tomography (PET) CT scan showed an intense uptake of the L4-L5 space (figure 1C). Blood and CT-guided discovertebral cultures remained sterile (including for mycobacteria) and 16s PCR and in-house specific Coxiella burnetii PCR were negative. C. burnetii serology (Focus diagnostics Q fever immunofluorescent antibody IgG and IgM test kits) was positive and in favour of a chronic Q fever (phase I, IgG 2048; phase II, IgG 4096; IgM were negative). Brucella and Bartonella were negative. An echocardiogram was performed to exclude vegetations caused by bacterial endocarditis. The patient was treated with doxycycline (200 mg/day) and hydroxychloroquine (400 mg/day) for 10 months. A significant improvement with reduction of the back pain was noticed and the CRP remained <2.9 mg/L. The antibody titres decreased and the pathological uptake of the L4-L5 space on PET scan disappeared when antibiotics were stopped (figure 1D).

Disappearance of FDG uptake on PET scan after antimicrobial therapy could help for the diagnosis of Coxiella burnetii spondylodiscitis.

Signorelli F
Membro del Collaboration Group
;
2016

Abstract

A 55 year-old man was admitted for worsening of a chronic low back pain associated with L4-L5 anterolisthesis, despite taking non-steroidal anti-inflammatory drugs for several months. He had a medical history of high blood pressure and obesity (body mass index, 37 kg/m2). He lived in the countryside but had no direct contact with animals except his dog. There were no fever, chills, sweats or weight loss. C reactive protein (CRP) was <2.9 mg/L. Radiographs showed L4-L5 anterolisthesis with endplate erosions and bony sclerosis (figure 1A). On MRI (figure 1B), there was a significant enhancement of L4-L5 vertebral endplates and paravertebral soft tissues. Positron emission tomography (PET) CT scan showed an intense uptake of the L4-L5 space (figure 1C). Blood and CT-guided discovertebral cultures remained sterile (including for mycobacteria) and 16s PCR and in-house specific Coxiella burnetii PCR were negative. C. burnetii serology (Focus diagnostics Q fever immunofluorescent antibody IgG and IgM test kits) was positive and in favour of a chronic Q fever (phase I, IgG 2048; phase II, IgG 4096; IgM were negative). Brucella and Bartonella were negative. An echocardiogram was performed to exclude vegetations caused by bacterial endocarditis. The patient was treated with doxycycline (200 mg/day) and hydroxychloroquine (400 mg/day) for 10 months. A significant improvement with reduction of the back pain was noticed and the CRP remained <2.9 mg/L. The antibody titres decreased and the pathological uptake of the L4-L5 space on PET scan disappeared when antibiotics were stopped (figure 1D).
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11586/240734
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