Images in Clinical Medicine
Acute Vertebral Osteomyelitis
N Engl J Med 2003; 348:2525June 19, 2003
- Article
A 77-year-old man with diabetes presented with a four-day history of fever and worsening left-sided neck and shoulder pain accompanied by numbness and paresthesias in the fingers of the hand on the same side. Physical examination revealed severely restricted neck movement and marked palpable neck tenderness over the fourth, fifth, sixth, and seventh cervical vertebrae. The patient underwent integrated positron-emission tomographic and computed tomographic scanning because a pacemaker was present and magnetic resonance imaging could not be performed. The scans (Panels A and B) demonstrated an intense focal area of abnormal hypermetabolism confined to the left aspect of the fourth cervical vertebral body (arrow, Panel A) that was consistent with the presence of an infection. A blood culture grew Enterococcus faecalis that was sensitive to ampicillin. The patient received intravenous gentamicin and ampicillin and had prompt resolution of fever, followed by a steady decrease in pain.
Michelle V. Lee, M.D.
Anthony Minotti, M.D.
MetroHealth Medical Center, Cleveland, OH 44109
