Article Text

THU0262 Multifocal Infectious Spondylodiscitis in Central Tunisia: Clinical and Therapeutic Features
  1. Z. Alaya1,
  2. M. Bouzaouache1,
  3. K. Baccouche1,
  4. H. Zaghouani2,
  5. S. Belghali1,
  6. D. Amri1,
  7. H. Zeglaoui1,
  8. E. Bouajina1
  1. 1Rheumatology department
  2. 2Radiology department, Hospital Farhat Hached, SOUSSE, Tunisia


Background The infectious spondylodiscitis is the location of a microbial agent to the body of the vertebra associated with disc disease. It is called multifocal when the spinal involvement of several floors is not contiguous. It is seen especially in immunocompromised patients.

Objectives The objective of our study was to describe the clinical, biological, radiological and therapeutic aspects of multifocal infectious spondylodiscitis.

Methods This is a retrospective study of 84 cases of infectious spondylodiscitis collected in department of Rheumatology over a period of 15 years [1999-2014]. Multifocal infectious spondylodiscitis was observed in 6 cases.

Results Our population consists of 4 men and 2 women. The mean age was 52 years [36-64]. One patient was diabetic. The tuberculous origin was retained in 5 cases and the Brucella origin in one case. The mean disease duration was 5 months [1-12 months]. The start mode was progressive in all cases. The circumstances of discovery were inflammatory spinal pain in all cases associated to general signs such alteration of the general state and night sweats in 5 cases. Radicular pain was observed in 4 cases. Motor deficit was objectified in 4 cases. An array of spinal compression occurred in 2 cases. The biological inflammatory syndrome was observed in all cases. X-ray showed disc space narrowing in 6 cases and erosion of the vertebral endplates in 3 cases. MRI performed in 5 cases showed a typical appearance of infectious spondylodiscitis in all cases, an epiduritis in one case, an infiltration of the soft parts in 5 cases and spinal cord compression in 2 cases. Spondylodiscitis interested lumbar spine in one case, thoracic and lumbar spine in 3 cases and lumbar and cervical spine in 2 cases. All patients benefited of disco-vertebral puncture biopsy. Histological examination was specific for tuberculosis in 3 cases. The tuberculous origin was retained in 2 cases based on clinical and radiological data. The Brucella serology was positive in one case. All patients with tuberculous spondylodiscitis were put on anti tuberculosis treatment. The patient with brucella spondylodiscitis was put on association of cyclin and rifampicin. The evolution was unfavorable in one case with persistence of neurological sequelae.

Conclusions Multifocal infectious spondylodiscitis can occur in immunocompetent individuals. The causative organisms are dominated by tuberculosis. Treatment should be initiated as soon as possible to avoid neurological sequelae especially.

Disclosure of Interest None declared

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