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@ARTICLE{Mirbagheri:179321,
author = {A. Mirbagheri and N. Etminan and S. Schölch$^*$ and C.
Maier$^*$ and J. Perrin and F. Enders},
title = {{L}umbar spondylodiscitis-mimicking cholecystitis - a case
report and review of literature.},
journal = {Journal of neurological surgery / A},
volume = {84},
number = {1},
issn = {2193-6315},
address = {Stuttgart},
publisher = {Thieme},
reportid = {DKFZ-2022-00589},
pages = {95-102},
year = {2023},
note = {2023 Jan;84(1):95-102},
abstract = {Lower back pain is a frequent cause of Emergency Department
visits and one of the leading causes of the disease burden
worldwide. The purpose of this case report and literature
review was to discuss atypical abdominal entities mimicking
spinal diseases typically presenting with lower back pain.A
79-year-old male presented with lower back pain and urinary
incontinence after receiving a non-image-guided lumbar
infiltration treatment four weeks prior to admission. The
MRI highlighted multi-segmental hyperintensities in the
intervertebral disc spaces of the lumbar spine indicative
for spondylodiscitis. Antibiotic treatment over a week did
not lead to significant clinical improvement. Blood
cultures, cardiologic, otorhinolaryngologic and dental
examinations turned out negative for a focus of infection. A
CT-guided biopsy was indicated after discontinuation of
antibiotic treatment for less than 24 hours. Rapid clinical
deterioration with concomitant onset of abdominal pain
resulted in the diagnosis of cholecystitis, which required
cholecystectomy. We performed a systematic literature review
using the Pubmed database for the key words
'spondylodiscitis', 'spine', 'abdominal' and
'cholecystitis', to identify abdominal diseases that mimic
spine pathologies and spinal diseases that mimic abdominal
pathologies.No other report in English literature of
cholecystitis associated with initial onset of lower back
pain was identified. Eighteen reports referred to abdominal
conditions that mimic spinal diseases among them a patient
with cyclic lumbar back pain who received a lumbar spinal
fusion who, after persisting symptoms led to further
diagnostic procedures, was ultimately diagnosed with
endometriosis. Spinal symptoms included paraplegia and
urinary incontinence as results of acute aortic pathologies.
Eleven reports presented spinal pain mimicking abdominal
conditions including abdominal pain and diarrhea as well as
have had surgical procedures such as an appendectomy before
the spinal condition was discovered.Clinical symptoms of the
spine such as lower back pain can be unspecific and lead to
false conclusions in the presence of concomitant pathologies
in MRI. Only clinical deterioration in our case patient
prompted correction of the diagnosis on day seven. Initial
workup for alternative common infectious foci such as lung
and urinary tract was performed, but further abdominal
workup despite the absence of abdominal symptoms may have
led to an earlier diagnosis. Our literature review found
several cases of misdiagnosed spinal and abdominal
conditions, respectively. Some had undergone unnecessary
invasive surgical procedures before the right diagnosis was
concluded. Because of the high incidence of symptoms such as
lumbar back pain as well as abdominal pain, considering
optimal patient care as well as economic aspects it would be
essential to conduct an interdisciplinary clinical
management to avoid errors in the early stage of
diagnostics.},
cin = {A430},
ddc = {610},
cid = {I:(DE-He78)A430-20160331},
pnm = {311 - Zellbiologie und Tumorbiologie (POF4-311)},
pid = {G:(DE-HGF)POF4-311},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:35354214},
doi = {10.1055/a-1811-7393},
url = {https://inrepo02.dkfz.de/record/179321},
}