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Abstract

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Article in Japanese

Case Report

Pyogenic vertebral osteomyelitis presenting with right pleural empyema in a rheumatoid arthritis patient: an autopsy case report

Yohsuke Sugiyamaa  Kouji Azumaa  Yumiko Samejimaa  Tetsuo Takataa  Kyongyob Mina  Misa Songb 

aRespiratory Division, Department of Internal Medicine, Itami City Hospital
bDepartment of Pathological Diagnosis, Itami City Hospital

ABSTRACT

A 76-year-old male was admitted to our hospital with complaints of lumbago and difficulty in movement. He had a two-year history of rheumatoid arthritis, treated with a combination of methotrexate and tocilizumab. His chest-abdominal computed tomography image demonstrated the destruction and compression of thoracolumbar vertebral bodies and right-sided pleural effusion. The right-sided pleural effusion was diagnosed as empyema due to methicillin-sensitive Staphylococcus aureus by bacterial analysis. T2-weighted spinal magnetic resonance imaging demonstrated an increased signal intensity at the level of Th12-L1, suggesting vertebral osteomyelitis. Antibiotics and tube drainage failed to cure the right-sided pleural empyema and vertebral osteomyelitis and the patient died. An autopsy revealed that vertebral osteomyelitis had caused the right-sided pleural empyema. This case suggests that exudative pleural effusion/empyema can be an unusual consequence of pyogenic vertebral osteomyelitis in immunocompromised patients with back pain.

KEYWORDS

Pyogenic vertebral osteomyelitis  Empyema  Rheumatoid arthritis  Tocilizumab 

Received 8 Aug 2019 / Accepted 16 Oct 2019

AJRS, 9(1): 33-37, 2020

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