email   Email Us: info@lupinepublishers.com phone   Call Us: +1 (914) 407-6109   57 West 57th Street, 3rd floor, New York - NY 10019, USA

Lupine Publishers Group

Lupine Publishers

  Submit Manuscript

ISSN: 2690-5760

Journal of Clinical & Community Medicine

Case reportOpen Access

Vertebral Osteomyelitis Masquerading as Pulmonary Embolism Volume 1 - Issue 5

Moe Ameri1,2*, Demian Omeh1 and Chris Elsayad3

  • 1Department of Internal Medicine, Nassau Medical University Center, USA
  • 2American University of the Caribbean School of Medicine, Netherlands
  • 3Division of Ambulatory Medicine, American University of the Caribbean and Clinical Associate Professor in Medicine, New York College of Osteopathic Medicine, USA

Received: March 03, 2020   Published: March 13, 2020

Corresponding author: Moe Ameri, American University of the Caribbean School of Medicine, Netherlands

 

Abstract PDF

Introduction

Clinical entities known to mimic the presentation of pulmonary embolism (PE) include pneumonia, asthma, bronchitis, chronic obstructive airway disease (COPD) flare, congestive heart failure, acute myocardial infarction, primary pulmonary artery sarcoma, and nephrolithiasis. Only two cases of vertebral osteomyelitis mimicking PE are found in the literature. We report a rare case of lumbar vertebral osteomyelitis presenting with pleuritic chest pain and shortness of breath, and therefore causing delayed diagnosis [1].

Case Presentation

58-year-old African American male presented to the emergency room with pleuritic chest pain, shortness of breath, back pain and white phlegm. He also endorsed night sweets, and dark stools for the past few days. His past medical history includes hypertension, dyslipidemia, deep vein thrombus, three previous episode of pulmonary embolism, coronary artery disease with percutaneous coronary intervention, and paroxysmal atrial fibrillation on Eliquis and Plavix. On presentation patient was anxious, in acute distress and likened his symptoms to the same symptoms he felt when he had his previous episode of pulmonary embolism. He was afebrile, patient had an oxygen saturation of 91% on room air. The rest of the physical exam was significant for irregularly irregular heart rhythm, left lower quadrant, and left-sided costovertebral angle tenderness. Computed tomography (CT) pulmonary angiography was negative for pulmonary embolism. He had leukocytosis, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. A CT of Abdomen/Pelvic with IV contrast, showed evidence of left psoas retroperitoneal hematoma. A Magnetic resonance imaging (MRI) of the thoracic and lumbar spine was done and confirmed a left psoas abscess and osteomyelitis of the L3/L4 vertebrae. Computed tomography (CT) guided aspiration of the psoas abscess was done. Aspirate grew (MSSA) as well. Transesophageal echocardiography (TEE) did not reveal any valvular vegetation thus ruling out endocarditis. Subsequent blood cultures were taken to monitor the patient’s bacteremia, patient was started on 6-day course of an intravenous Nafcillin and Azithromycin. Following four negative blood cultures, a peripherally inserted central catheter was inserted into the patient’s arm, and he was given a 3 weeks course of intravenous course of piperacillin and tazobactam. He was discharged to follow up with outpatient infectious diseases and physical therapy (Figures 1-4) [2].

Figure 1: CT Abdomen/Pelvic with IV contrast.

Lupinepublishers-clinical-community-medicine

Figure 2: CT Pulmonary Embolism Angiography with and without Dye.

Lupinepublishers-clinical-community-medicine

Figure 3: Mediastinal Chest CT with Contrast.

Lupinepublishers-clinical-community-medicine

Figure 4: MRI Thoracic & Lumbar with IV contrast.

Lupinepublishers-clinical-community-medicine

Introduction

References

  1. Fritz JM, Mcdonald JR (2008) Osteomyelitis: Approach to Diagnosis and Treatment. Phys Sportsmed 36(1): 50-4.
  2. Momodu II, Savaliya V (2019) Osteomyelitis. StatPearls.
  3. Pigrau C, Rodríguez-Pardo D, Fernández-Hidalgo N, Moretó L, Pellise F, et al. (2015) Health Care Associated Hematogenous Pyogenic Vertebral Osteomyelitis. Medicine 94(3): 365.
  4. Rivaud, Yayone, Maldjian, Pierre (2018) Clot or Not? Mimics of Acute Pulmonary Embolism on CT. Contemporary Diagnostic Radiology 41(3): 1-7.
Close

Online Submission System

Drag and drop files here

or

Browse Files
( For multiple files submission, zip them in a single file to submit. For file zipping software Download )