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SPONDYLODISCITIS: A POSSIBLE INFECTIOUS COMPLICATION IN PATIENTS ON HOME PARENTERAL NUTRITION
G Huard1, M Bouin1, M Lemoyne1, A Dupont1, A Potocki1, L Arbic1, L D’Aoust*1
1Gastroenterology and nutrition, Hôpital Saint-Luc, Université de Montréal, Montréal, Quebec
Disclosure of Interest:I declare that I do not have any affiliation with or financial interest in a commercial organisation that poses a conflict of interest.
Rationale: Home Parenteral Nutrition (HPN) is associated with a risk of catheter-related infection with consecutive hematogenous spread. However, no case of spondylodiscitis has been described in the litterature. We report the first three cases of spondylodiscitis in patients with HPN.
METHODS: Retrospective chart review of all patients receiving HPN from 2001 to 2006 was conducted. Cases of spondylodiscitis were searched. The diagnosis of spondylodiscitis was established on clinical criteria (lumbar or dorsal pain with fever > 38°C), spine imaging studies [computed tomography (CT), magnetic resonance imaging (MRI)] and microbiological criteria (peripheral vein and catheter blood cultures).
RESULTS: 33 patients received HPN during the studied period. Three cases of spondylodiscitis were identified. All complained of dorsal or lumbar pain with fever. Spine X-rays were normal in all cases. Only one patient had a CT, which was not specific for spondylodiscitis. The MRI and gallium scanning confirmed the diagnosis in all patients. The blood cultures from peripheral vein and catheter were positive in all three cases for Staphylococcus epidermidis (n=2) or Staphylococcus lugdunensis (n=1). A six weeks antibiotic therapy allowed a complete resolution of the infection among the three patients.
CONCLUSIONS: Spondylodiscitis is a possible infectious complication in patients receiving HPN. Spondylodiscitis must be part of the differential diagnosis among patients with HPN who complain of back pain with associated fever. Any suspicion of this pathology justifies conducting an MRI and gallium scanning.