Abstract
Objective: To describe a case of Corynebacterium discitis following a lumbar puncture (LP) in a 52-year-old patient with human immunodeficiency virus (HIV) infection.
Background: Though an uncommon complication, discitis has been described following LP. Presenting symptoms include low-back pain, tenderness, spasm, fever, and malaise, typically several weeks to months post-procedure. Laboratory studies may show elevated inflammatory markers. Magnetic resonance imaging (MRI) is the diagnostic modality of choice.
Design/Methods: Case report
Results: A 52-year-old man with well-controlled HIV underwent an elective LP which was complicated by multiple failed attempts prior to successfully obtaining cerebrospinal fluid which was noted to be grossly bloody. He reported low back pain the following day that resolved within 24 hours. However, two weeks later, he again developed significant low back pain for which he saw his primary care doctor (PMD). Laboratory studies were normal, and he was prescribed analgesics. The pain persisted, and he had multiple visits to his PMD in which further conservative management was recommended. Eventually the pain became so severe that he presented to the emergency room two months after undergoing the LP. On presentation he had a leukocytosis (white blood count 20.7) and mildly elevated erythrocyte sedimentation rate (37). Neurological examination was non-focal. MRI was concerning for discitis. Discectomy of the L2–L3 disc was performed. Pathology revealed foci of necrosis and bacterial cultures grew Corynebacterium. Symptoms resolved after the patient was treated with intravenous antibiotics for 6 weeks.
Conclusions: While back pain is a common symptom following LP, physicians should also be aware of discitis as a rare, but potential, complication in patients with persistent pain even in the absence of focal neurological deficits and laboratory abnormalities. Our case also supports the hypothesis that multiple attempts during an LP may be a risk factor for post-LP discitis.
Disclosure: Dr. Doherty has nothing to disclose. Dr. Saylor has nothing to disclose.
Disputes & Debates: Rapid online correspondence
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