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Kuczkowski, Krzysztof M. MD
Director, Obstetric Anesthesia, Assistant Clinical Professor, Departments of Anesthesiology and Reproductive Medicine, University of California, San Diego, San Diego, CA
I read with interest the article by Patel et al1 which describes an elderly immunocompromised man who developed intractable back pain following cytotoxic curative chemotherapy for non-Hodgkin lymphoma. I agree with the authors that septic discitis is an important, although often overlooked, differential diagnosis of back pain in immunocompromised individuals following chemotherapy, and should be seriously considered in any situation associated with bacteremia in these patients.
In his practice of anesthesiology and pain management, the author of this letter has encountered a 64-year-old female patient who presented with a 2-month history of intractable back pain of “unknown etiology at presentation,” following chemotherapy for advanced stage gynecological cancer. The septic discitis in our patient was finally attributed to an infected peripheral venous catheter in the immediate postchemotherapy period (Staphylococcus aureus bacteremia), and the diagnosis was confirmed by magnetic resonance imaging of the lumbar spine and fluoroscopically guided fine needle aspiration of the lumbar disc space (cultures yielded S aureus). This report also provides one more piece of evidence that in immunocompromised patients, peripheral vascular catheters should be inserted with careful aseptic technique, and removed as soon as they are no longer indicated.
Krzysztof M. Kuczkowski, MD
Letters to the Editor are welcomed. They may report new clinical or laboratory observations and new developments in medical care or may contain comments on recent contents of the Journal. They will be published, if found suitable, as space permits. Like other material submitted for publication, letters must be typewritten, double-spaced, and submitted in duplicate. They must not exceed two typewritten pages in length. No more than five references and one figure or table may be used. See “Information for Authors” for format of references, tables, and figures. Editing, possible abridgment, and acceptance remain the prerogative of the Editors.
© 2004 Southern Medical Association
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