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Septic Arthritis of a Lumbar Facet Joint Caused by Staphylococcus aureus

Rombauts, Pascale A. MD*; Linden, Patrick M. MD†; Buyse, Annemie J. MD†; Snoecx, Michel P. MD†; Lysens, Roeland J. MD, PhD*; Gryspeerdt, Stefaan S. MD‡

Case Reports

Study Design. Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint.

Objectives. To report a rare case of severe low back pain and the specific differential diagnostic problems.

Summary of Background Data. Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion.

Methods. The etiology, clinical presentation, technical examinations, and treatment are reviewed.

Results. Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient.

Conclusions. With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.

Septic arthritis of the peripheral joints most frequently involves the knee, followed by the hips, shoulders, wrists, ankles, and elbows, respectively. The sternoclavicular and sacroiliac joints might be preferred spots in intravenous drug users. 1 However, septic arthritis of a lumbar facet joint is rare, with only a few cases reported in literature since 1981. In view of the serious complications with possible fatal outcome, we considered it worthwhile to present our case, especially because of the young age of the patient, 35 years of age, in comparison with the average age of 65 years at onset taken from the literature. 7

From the *Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Leuven, Belgium; the †Departments of Physical Medicine and Rehabilitation and ‡Radiology, City Hospital, Roeselare, Belgium.

Acknowledgment date: July 8, 1999.

Acceptance date: October 12, 1999.

Address reprint requests to

Patrick M. Linden, MD

Department of Physical Medicine and Rehabilitation

City Hospital

Brugsesteenweg 90

8800 Roeselare, Belgium

E-mail: patrick.linden@skynet.be

Device status category: 1.

Conflict of interest category: 12.

© 2000 Lippincott Williams & Wilkins, Inc.