Lumbar facet joint septic arthritis presenting atypically as acute abdomen – A case report and review of the literature

Abstract

HighlightsSeptic arthritis of the facet joint is rare and often has an atypical presentation.Early clinical diagnosis is therefore elusive.Magnetic Resonance Imaging and blood culture are useful in the diagnosis.Conservative treatment with prolonged sensitive antibiotics is curative.

Acute medullar compression secondary to a septic arthritis of a thoracic facet joint: a case report and review of literature

“…Clinical signs and symptoms can vary between patients, and may resemble other pathologies such as spondylodiscitis [3,5,8,9] or pyelonephritis [6,8]. SAFJ generally presents as a unilateral back pain with often radiation to the flank or buttocks [2,3,6,8]. SAFJ seems to present with more acute and severe symptoms in early stages than spondylodiscitis [3].…”

“…There are only three more cases described in the literature with SAFJ in the thoracic spine [3,7,10]. Diabetes mellitus and other immunosuppressive diseases such as chronic liver disease, alcoholism or corticosteroid therapy have been described as risk factors to develop SAFJ [2,3,[6][7][8]. There have been cases of iatrogenic infection after invasive procedures like epidural injection, acupuncture or spinal surgery [3][4][5][6]11].…”

“…MRI remains as the gold standard for image diagnose [2][3][4][5][6][7][8]. Plain radiographs are not useful for diagnosis of SAFJ in early stages because radiologic abnormalities appear 6 to 12 weeks after the onset of symptoms [1-3, 5, 6].…”

“…It is mandatory to identify the microorganism that causes the SAFJ. In cases where blood culture results are negative, an aspiration of the articular liquid of the facet joint needs to be performed [3,6,8].…”

“…Since the most common cause of SAJF is haematogenous spread [2,4,[6][7][8], it is important to search for any possible pathogen entry portals, although they remain unknown in one third of the patients [4]. Blood cultures must be done for all cases with suspicion of SAFJ before initiating any antibiotic treatment.…”