Asymptomatic spondylodiscitis and epidural abscess in “newly” diagnosed diabetes mellitus

A 55 yr old patient (BMI 22), was admitted to our clinic due to “newly” diagnosed diabetes mellitus and in a reduced clinical state. Hb1Ac was 11,4%, indicative of an already longer-standing condition, GAD-Antibodies were negative. He had leucocytosis with 37,3 Gpt/l, Procalcitonin was 5.31 µg/l and CRP 229 mg/l. A low-T3-low-T4-Syndrome underlined the severeness of the disease. Staph. aureus was detected in blood and urine cultures, but no focus could be identified after chest x ray, ultrasonography of the abdomen and transoesophageal echocardiogram. Antibiotic therapy with Piperacillin and Tazobactame proved ineffective. Although the patient reported no pain in the spine at all and was asymptomatic during percussion, we extended our diagnostic approach to a MRT of the spine. The patient suffered from spondylodiscitis C 6/7 with epidural ventral abscess formation. He underwent surgical abscess evacuation and ventral fusion C 6/7.

Spondylodiscitis and spinal epidural abscesses are rare events. Diabetes is the main predisposing factor associated with the condition(s). In particular untreated patients with a presumably long prequel of the disease are at high risk. The longer untreated prequel may be associated with loss of pain perception as in this very case. Thus, even in completely asymptomatic diabetic patients with signs of septicaemia, spondylodiscitis needs to be considered.

Fig. 1: Spondylodiscitis