Spondylodiscitis associated with multiple level involvement and negative microbiological tests: an unusual case.

STUDY DESIGN: A case report. OBJECTIVE: To report an unusual case of spondylodiscitis with multiple level involvement. SUMMARY OF BACKGROUND DATA: Spondylodiscitis, an infection of the intervertebral disc space, vertebral bodies, or the paraspinal epidural space can be a serious disease because of diagnostic delay and inadequate treatment. METHODS: A previously healthy, 52-year-old man was presented to our outpatient clinic with a complaint of acute, atraumatic onset of severe back pain for more than 1 month. Initially, he was misdiagnosed at another clinic as myofascial pain and treated with nonsteroidal anti-inflammatories and physical therapy, which he did not benefit from. He never complained of fever; however, laboratory tests revealed raised erythrocyte sedimentation values, increased C-reactive protein values but normal leukocyte count. Thoracal and lumbal plain radiographs were nonspecific. Magnetic resonance imaging demonstrated increased signal intensity in vertebral bodies and intervertebral disc space through T12-L4 and in the paravertebral musculature at L2-L3 with contrast enhancement. Blood cultures and computed tomography-guided needle biopsy and cultures were negative. RESULTS: The patient was treated with oral amoxicillin and clavulanate and responded very well clinically; however, imaging examinations were repeated up to 6 months because of multilevel involvement. Follow-up magnetic resonance imaging findings at 3 months and 6 months showed decreased signal intensity, and luckily, there was no evidence of vertebral destruction. CONCLUSION: Diagnosis of spondylodiscitis could be challenging and commonly missed; however, it should always be included in the differential diagnoses of back pain in the middle aged and healthy population.

Serum albumin and comorbidity relative to rehabilitation outcome in geriatric stroke, and possible links with stroke etiology.

Factors that describe the disability status of the stroke patient on discharge are important when starting a rehabilitation program, both from a psychosocial and a financial point of view. The objective of this study was to assess how comorbidity and serum albumin levels relate to rehabilitation outcome in geriatric stroke patients. Another aim was to assess whether stroke etiology (ischemic or hemorrhagic) influences these links. Medical records of 80 patients (68 ischemic and 12 hemorrhagic strokes) older than 65 years, who had suffered their first stroke, were investigated. Functional performance levels at admission and discharge were evaluated using the Functional Independence Measure (FIM). Length of stay in hospital was recorded. Serum albumin levels and comorbidity scores on admission were noted. Correlations between these variables and differences between the groups categorized according to stroke etiology were analyzed. In the group of geriatric stroke patients as a whole, serum albumin level was correlated with FIM score at admission and discharge. Comorbidity score was negatively correlated with length of stay. In the ischemic stroke subgroup, serum albumin level was positively correlated with length of stay and with functional gain, and comorbidity score was negatively correlated with functional gain. Analysis of the data for the hemorrhagic stroke subgroup revealed none of these correlations. It was concluded that serum albumin level and comorbidity are useful indices in geriatric ischemic stroke patients for predicting functional outcome and time spent in rehabilitation.