Department of Rheumatology, Morriston Hospital, Morriston, Swansea SA6 6NL, UK
SIR, Spinal infection is an uncommon cause of back pain, most cases being due to haematogenous spread of infection and a small minority to direct bacterial inoculation of the spine [1]. Cases of cervical osteomyelitis occurring after oesophageal [2] and laryngeal [3] trauma have been described previously. We have encountered a case where the spondylodiscitis was closely associated with a metal oesophageal stent used in the treatment of oesophageal carcinoma.
The patient, a 70-yr-old female, was diagnosed with an invasive squamous cell carcinoma in the upper third of the oesophagus in November 2000. She was treated by laser ablation and dilatation. An isotope bone scan showed minor uptake consistent with osteoarthritis in January 2001.
In February 2001 an uncovered metal stent was inserted in a good position to treat continuing dysphagia. Known to suffer from symptoms of cervical spondylosis, she presented to the rheumatology department in November 2001 complaining of increasing neck pain and paraesthesiae in a C7T1 distribution.
An MRI of the cervical spine showed typical appearances of an infective spondylodiscitis of C7T1 vertebrae, adjacent to the upper border of the oesophageal stent. Blood cultures were negative and her anti-staphylolysin level was not elevated. It was felt that direct aspiration of the infected material was not clinically justified, and she was treated empirically with parenteral flucloxacillin and ciprofloxacin. She made a prompt symptomatic response.
We suggest that the infection was due to direct spread of organisms from the oesophagus in relation to the stent. This complication has been described only once previously, when an epidural abscess was reported [4] in a patient with an oesophageal stent for benign disease. Oesophageal stents are used for the treatment of dysphagia due to carcinoma, with increasing frequency, and rheumatology departments may encounter vertebral infection in relation to them.
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