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Gas Forming Infection of the Spine: a Case Report

  • Surgery
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Abstract

Gas-forming infection is a rapidly progressive and life-threatening soft tissue infection. Gas-forming infection with spine manifestations is extremely rare and can be a result of several entities including necrotizing fasciitis (NF) and emphysematous osteomyelitis. We present a case of a 68-year-old man who presented with a 1 week back pain and fever. His lab results supported a high-intensity inflammation process. Due to a positive urinalysis, he was treated for a urinary tract infection as the suspected origin to his symptoms. Shortly following admission, the patient’s condition declined. Following an orthopedic surgeon consultation, a CT scan of the lumbar spine was obtained and demonstrated gas-forming infection process that involved the spine, epidural space, and surrounding muscles. The patient underwent several surgical procedures in attempt to reduce the infected tissues and the local pressure. Despite aggressive debridement of the spine and maximal medical therapy, the patient passed away due to multisystem organ failure. Spine involvement in gas-forming infection is a rare entity with very poor prognosis, requiring early and aggressive surgical treatment. A multidisciplinary approach is necessary for management. Nevertheless, even with proper and optimal management, multisystem failure and mortality still may occur.

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Abbreviations

GFI:

gas-forming infection

NF:

necrotizing fasciitis

EOM:

emphysematous osteomyelitis

WBC:

white blood cell count

CRP:

C-reactive protein level

Hb:

hemoglobin

PLT:

platelet count

CK:

serum creatine kinase

CT:

computed tomography

MRI:

magnetic resonance imaging

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Authors and Affiliations

  1. Department of Orthopedic Surgery and the Spine Unit, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Yossi Smorgick, Eran Beit Ner & Yoram Anekstein

  2. Department of Radiology, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Tal Granek & Sigal Tal

  3. Intensive Care Unit, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Ayana Dvir

  4. Infectious Diseases Unit, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Ariela Levcovich

Authors
  1. Yossi Smorgick
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  2. Eran Beit Ner
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  5. Sigal Tal
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  7. Yoram Anekstein
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Correspondence to Eran Beit Ner.

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Conflict of Interest

All authors declare that they have no conflict of interest relevant to this case or paper.

Other disclosures are provided on the disclosure form.

Informed Consent

We did not acquire an informed consent from the patient’s next in kin. The given information is anonymized, and the submission does not include images or other information that may identify the deceased. We believe that it is very important to share information of the presented case of such a rare disease with very poor prognosis with our colleagues, in order to contribute to our joint understanding of this disease. Due to its clinical importance, our IRB\Ethics committee has discussed the case and gave a waiver for the need of a formal review which is attached with the cover letter.

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Smorgick, Y., Beit Ner, E., Granek, T. et al. Gas Forming Infection of the Spine: a Case Report. SN Compr. Clin. Med. 2, 1008–1011 (2020). https://doi.org/10.1007/s42399-020-00337-6

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