Case reports: spondylodiscitis and epiduritis after suffering COVID-19

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Abstract

Background: The study analyzes a possible rare complication of COVID-19 in the form of spondylodiscitis, including that followed by epiduritis, in patients who survived COVID-19 characterized by severe pneumonia, respiratory failure and systemic inflammatory response syndrome (SIRS).

Clinical case description: Three clinical cases of patients are presented, each of whom had high fever, SIRS with a significant increase in the laboratory markers of inflammation (C-reactive protein (CRP), leukocytosis, erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, ferritin), bacterial pneumonia, and severe hemostasis disorders. Despite an antibiotic therapy with broad-spectrum drugs, the development of spondylodiscitis was observed, manifested as acute pain syndrome in the lumbar spine. In the first patient, against the background of a massive antibacterial therapy, revisions of purulent foci, therapy with glucocorticosteroids (GCS), and a surgical treatment, there was significant positive dynamics in the form of the pain syndrome relief. The second patient showed positive dynamics against the background of a conservative antibacterial therapy. The third patient, with a paravertebral abscess at the level of developed spondylodiscitis, received a massive antibiotic therapy combined with GCS, and was operated for the spinal cord decompression.

Conclusion: Spondylodiscitis and epiduritis may be possible complications of COVID-19, including those resulting from the immunosuppressive therapy, which is actively used to stop the cytokine storm.

About the authors

Ilya I. Ustenko

Academician I.P. Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: ustenko.ilya1997@gmail.com
ORCID iD: 0000-0003-3950-2684

Clinical Resident, first neurology department, MD

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197022

Yana B. Kushnir

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: kushnir.yana2014@yandex.ru
ORCID iD: 0000-0001-7891-9883

Neurologist, first neurology department, MD

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197022

Alexandr V. Amelin

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: avamelin@mail.ru
ORCID iD: 0000-0001-6437-232X
SPIN-code: 2402-7452

MD, PhD, Professor, Neurology department

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197022

Andrey А. Gotovchikov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: gotovchikov_73@mail.ru
ORCID iD: 0000-0002-8567-6442

neurologist, head of the first neurology department, MD

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197022

Denis V. Goranchuk

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: gordenisval@mail.ru

neurosurgeon, head of the Department of Neurosurgery, MD

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197022

Alexander N. Kulikov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: ankulikov2005@yandex.ru
ORCID iD: 0000-0002-4544-2967
SPIN-code: 3851-6072

MD, PhD, Professor, deputy chief physician of the clinic for medical part in therapy

Russian Federation, 6/8, Lva Tolstogo street, St. Petersburg, 197022

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2. Fig. 1. Patient V., 58 years old: сomputed tomography of the chest organs indicates moderate pneumonia (CT-2).

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3. Fig. 2. The same patient: magnetic resonance imaging of the lumbar spine: а — axial slice in T2-FLAIR mode at the L5–S1 level; б — sagittal slice of the spinal column in T2-FLAIR mode; в — sagittal slice of the spinal column in STIR mode. Arrows (б, в) indicate the focus of spondylodiscitis.

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4. Fig. 3. Patient D., 69 years old: сomputed tomography of the chest organs indicates a severe degree of pneumonia (CT-3).

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5. Fig. 4. The same patient: magnetic resonance imaging of the lumbar spine: а — axial slice in T2-FLAIR mode at the L4–L5 level; б — sagittal slice of the spinal column in T2-FLAIR mode. The arrow (б) indicates the focus of spondylodiscitis.

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6. Fig. 5. Patient L., 75 years old: computed tomography of the chest organs indicates moderate pneumonia (CT-2).

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7. Fig. 6. The same patient: magnetic resonance imaging of the lumbar spine: а — axial slice in T2-FLAIR mode at the L2–L3 level; б — sagittal slice of the spinal column in T2-FLAIR mode; в — sagittal slice of the spinal column in STIR mode. Arrow indicates an abscess (а); abscess (б) and the spondylodiscitis (в) focus is outlined.

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Copyright (c) 2022 Ustenko I.I., Kushnir Y.B., Amelin A.V., Gotovchikov A.А., Goranchuk D.V., Kulikov A.N.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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