Pyogenic Spondylitis Accompanied by Urinary Tract Infection and Septic Arthritis of the Knee: A Case Report

Vertebral spondylitis is difficult to diagnose and
is often treated as fever of unknown origin. We
encountered a 46-year-old man with complaints of
fever and back pain. He had costovertebral angle
tenderness on percussion and elevated inflammatory
markers on blood biochemistry; he was suspected to
have urinary tract infection. A likely cause of fever,
such as pyelonephritis, was elusive on non-contrast
chest/abdomen/pelvis computed tomography and subsequent
contrast computed tomography and magnetic
resonance imaging. Specialist radiology review was
suggestive of vertebral spondylitis. Physical reexamination
revealed numbness and muscle weakness consistent
with the location of the lesions. Conservative
antibiotic treatment was initiated. Septic right knee
joint was also suspected, and arthroscopic washout
with débridement was urgently performed. Inflammatory
markers improved on conservative antibiotic
treatment. In emergency settings, thorough physical
examination and coordination between medical specialists
is crucial.