Re: Polytopic spondylodiskitis secondary to Streptococcus bovis endocarditis

W. P. Butt

St James's University Hospital, Leeds LS9 7TF, UK

SIR, In a recent letter, Drs G. García-Pardo, T. Auguet, J. L. Blanco, O. Araújo, A. Lorenzo and C. Richart describe a case of polytopic spondylodiscitis secondary to Streptococcus bovis endocarditis. They illustrated the spinal involvement with MRI of the lumbar spine, but the illustration does not match the caption. The examination illustrated is a T2-weighted rather than a T1-weighted image and does not include the cervical spine. These are minor matters compared with the fact that the illustrations do not show what is described. Spondylodiscitis is extremely difficult if not impossible to diagnose on a T2-weighted image alone and is certainly impossible to illustrate. Adequate examination requires T1-weighted imaging after gadolinium.

One is grateful to the authors for pointing out the importance of spondylodiscitis as a cause of back pain in the elderly and also the importance of looking for endocardial lesions in patients with multifocal bone infection. It is unfortunate that their illustrations let them down.

Accepted 24 January 2000





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