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Case Report
Vertebral osteomyelitis presenting as locally invasive lung cancer
1 OMS-III, Medical Student, University of New England, College of Osteopathic Medicine, Biddeford, ME, USA
2 MD, Internal Medicine, Northern Light AR Gould Hospital, Presque Isle, ME, USA
3 MD, Diagnostic Radiology, Northern Light AR Gould Hospital, Presque Isle, ME, USA
Address correspondence to:
Matthew L Cloutier
11 Hills Beach Rd., Biddeford, ME 04005,
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Article ID: 100063Z09MC2021
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Cloutier ML, White JA, Mautz AP. Vertebral osteomyelitis presenting as locally invasive lung cancer. J Case Rep Images Med 2021;7:100063Z09MC2021.ABSTRACT
Introduction: Vertebral osteomyelitis is a spinal infection that most commonly presents with insidious back pain, sometimes accompanied by other non-specific signs and symptoms. It most commonly results from hematogenous seeding of Staphylococcus aureus. Due to its frequently non-specific presentation, diagnosis is often delayed until the disease is advanced or neurologic sequelae have developed.
Case Report: A 54-year-old male presented to the hospital with three days of worsening pain in his upper back and an approximate 30-pound weight loss. He was afebrile and his physical exam was unremarkable aside from diffuse tenderness to palpation. Computed tomography scans showed a compression fracture of T4 without disc involvement or endplate destruction. An associated mass-like consolidation in the apical segment of the left lung appeared to be invading the chest wall posteromedially with lytic destruction of the fourth rib at the costovertebral junction. Patient history in conjunction with imaging findings was highly suggestive of locally invasive lung cancer. A biopsy was done, which yielded no evidence of malignancy. Cultures were sent after repeat biopsy and grew methicillin-sensitive S. aureus, yielding a presumptive diagnosis of vertebral osteomyelitis. Destruction of the patient’s thoracic spine progressed despite intravenous (IV) oxacillin and eventually required surgical intervention.
Conclusion: The indistinct presentation of vertebral osteomyelitis often poses a diagnostic challenge, particularly when characteristic imaging findings are not present. Due to the consequences of delayed diagnosis, vertebral osteomyelitis should be considered with a high index of suspicion when a patient presents with back pain.
Keywords: Lung cancer, Vertebral osteomyelitis
SUPPORTING INFORMATION
Acknowledgments
We thank Dr. Carol Brenner (University of New England College of Osteopathic Medicine) for her guidance throughout the process of writing and submitting this case report.
Author ContributionsMatthew L Cloutier - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Justin A White - Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alan P Mautz - Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Matthew L Cloutier et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
