Type of publication:
Journal article
Author(s):
*Ibraheem, Mustafa; *Al-Rubaye, Rafal; *Tanswell, Ian
Citation:
Cureus. 17(5):e84838, 2025 May.
Abstract:
This case illustrates the significant progression of pyelonephritis to vertebral osteomyelitis secondary to Escherichia coli bacteraemia, highlighting the potential for hematogenous dissemination from urinary
tract infections to the spine. A female patient in her 60s initially presented with fever, nausea, and diarrhoea, subsequently diagnosed with E. coli bacteraemia from pyelonephritis. Despite initial clinical
improvement with intravenous and oral antibiotics, her condition deteriorated over three hospital admissions, progressing to L1/L2 vertebral osteomyelitis complicated by bilateral psoas and epidural
abscesses. Her functional status markedly declined from independent ambulation to requiring assistance for mobilization. This case emphasizes critical lessons regarding the complexity of determining optimal
antibiotic therapy duration, especially when complicated by abscess formation and recurrent bacteraemia. It further underscores limitations associated with early transitions from intravenous to oral antibiotics in
complicated vertebral infections, advocating heightened clinical vigilance and a multidisciplinary approach to prevent diagnostic delays and severe functional impairment.
DOI: 10.7759/cureus.84838
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