Dorsal Lytic Lesions: Cancer or Infection?

TL;DR

This case study highlights the diagnostic importance of biopsies in distinguishing infection from cancer in spinal lesions.

Contribution

The paper emphasizes the role of biopsy in confirming spondylodiscitis and identifying the causative agent.

Findings

A biopsy confirmed methicillin-sensitive Staphylococcus aureus as the cause of spondylodiscitis in a patient with dorsal lytic lesions.

The patient responded to targeted antibiotic therapy and surgical intervention.

Biopsy was critical in guiding accurate diagnosis and treatment.

Abstract

Infectious spondylodiscitis is a rare disease and typically presents with an insidious progression characterized by spinal pain that usually starts gradually and progressively worsens over several weeks to months. It occurs through three main mechanisms: direct contamination in cases of trauma or surgery, hematogenous dissemination, or through contiguity.

We report the case of a 63-year-old male, admitted due to a history of dorsolumbar pain after falling from a height of 1.5 meters, with four months of evolution, without other accompanying symptoms, and refractory to anti-inflammatory and analgesic therapy. Initial laboratory evaluation revealed normocytic and normochromic anemia and a slight elevation in C-reactive protein. Computed tomography of the spine showed pathological fractures of T7-T9. A percutaneous biopsy was performed, positive for methicillin-sensitive Staphylococcus aureus, and the patient underwent 12 weeks of targeted antibiotic therapy. A surgical procedure with percutaneous posterior arthrodesis from T4 to T12 was performed.

With this case, the authors aim to emphasize the importance of biopsy as a complementary diagnostic method to imaging studies in the diagnosis of spondylodiscitis, with the possibility of identifying the causative agent.

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