Case Study

Bacterial discitis of the lumbar spine as a complication of longstanding neuropathic ulceration in a foot with Charcot's osteoarthropathy

A 55-year-old man with insulin-treated type 2 diabetes of 15 years' duration, peripheral neuropathy and impaired liver function due to previous hepatitis B infection presented late with acute Charcot's osteoarthropathy of

Fig. 5.13 The patient has undergone surgical debridement of his infected foot with rockerbottom deformity and plantar ulceration.

the right foot. Two years subsequently he developed neuropathic ulceration of the left 2nd toe. The ulcer became infected and he was admitted to hospital for intravenous antibiotics and underwent a ray amputation. He was discharged after 3 weeks. His left foot became red, swollen and warm, and Charcot's osteoarthropathy was diagnosed. He declined a total-contact cast but said that he would rest the foot as much as possible. (Two nights later one of the authors saw him in Central London at a Promenade Concert hiding behind a pillar so as not to be seen and reprimanded for not resting!) He developed a rockerbottom deformity with a neuropathic ulcer over the bony prominence, and re-presented with severe infection and spreading cellulitis. He was admitted for intravenous antibiotics and surgical debridement of the foot, with removal of infected soft tissue (Fig. 5.13). Three months later, he complained of severe pain in the region of his lumbar spine. An MRI scan revealed infection of the disc between the 4th and 5th lumbar vertebrae, which was treated with long-term antibiotics and resolved.

Key points

• Metastatic infection can develop from a primary infection in the foot

• Presentation of metastatic infection may be delayed.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

Get My Free Ebook


Post a comment