Ishita Mehra, MD, MBBS, MD
Resident Physician
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Vishidha Balankari, MD
Resident Physician
North Alabama Medical Center
Florence, Alabama, United States
Disclosure information not submitted.
Sindhoora Adyanthaya
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Brigette Thomas, MD
Resident Physician
North Alabama Medical Center, United States
Disclosure information not submitted.
Sucheta Kundu, MD
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Kamini Rao, MD
Resident Physician
North Alabama Medical Center, United States
Disclosure information not submitted.
Evans Kyei-nimako, MD
Attending Physician
North Alabama Medical Center
Florence, Alabama, United States
Disclosure information not submitted.
Title: A Case Presentation Of A Rare Complication Of Ankylosing Spondylitis
Case Report Body:
Introduction: Ankylosing spondylitis (AS) is a rare yet disabling cause of chronic back pain (CBP) accounting for 0.55% cases of CBP among US adults. Spondylodiscitis (SD), a term encompassing discitis and osteomyelitis, is an uncommon complication of AS and can often be missed as a diagnosis in patients with CBP.
Description: A 61-year-old morbidly obese Caucasian female presented with progressively worsening back pain since 6 months with an acute decompensation 2 days prior to presentation. She also had nausea and vomiting, fever, and acute decrease in her urine output. Her relevant past medical history included AS and peripheral arterial disease status post aorto-femoral bypass on oral anti coagulation with apixaban. In the ER, she was noted to be in severe painful distress. She had a temperature of 99.3F, tachycardia, BP 88/76, saturating at 97% on 3L oxygen via nasal cannula. Physical exam found her tender over her mid back, moving all her extremities spontaneously with no significant deficits in strength or reflexes with decreased sensations in her distal lower extremities. Labs were notable for leukocytosis, acute kidney injury (AKI) with BUN/creatinine 148/12.3 (normal baseline kidney function). She had a T8-T9 SD on CT of her thoracic spine. No neurosurgical interventions were recommended, but she required close monitoring in the critical care unit for acute neurological changes while being empirically treated with broad spectrum antibiotics and pain medications. AKI resolved with IV fluids. A CT guided biopsy was obtained and cultured, results were significant for Streptococcus agalactiae (GBS), and her antibiotics were de-escalated to IV ceftriaxone. Her hospitalization was complicated by thoracic cord compression with edema noted on MRI rendering her paraplegic with minimal improvement with IV steroids. She was completely bedbound and discharged to rehab on IV antibiotics for 6 weeks with close outpatient follow up.
Discussion: While thoracic SD is a rare complication of AS, very few case reports describe GBS spondylodiscitis in adults, making this case unique. Our patient was ambulatory prior to this acute deterioration which rendered her bedbound, putting an emphasis on the importance of working up disabling chronic back pain appropriately to identify such cases early and prevent lifelong disability.