Septic embolism of the lung due to spondylodiscitis

Tufanoğlu, Fatih Hakan; Akyüz, Behiç; Bekirçavuşoğlu, Süleyman

doi:10.1590/0037-8682-0662-2021

A 57-year-old male with respiratory distress and back and chest pain was admitted to the respiratory disease clinic in September 2021. He was referred from another hospital for right-sided spontaneous pneumothorax on radiographic examination. On arrival, he was tachypneic, and laboratory studies showed leukocytosis (32 × 10³ µL) and an elevated level of C-reactive protein (214 mg/L). Computed tomography (CT) of the thorax revealed right-sided pneumothorax and bilateral peripherally distributed multiple nodules with cavitation (Figures 1-2). Antibiotics were started and a chest tube was inserted. Blood cultures were negative, but the bronchial lavage culture revealed Staphylococcus aureus. The biopsy of the lung nodules showed lymphoplasmacytic infiltration and inflammation. A week after admission, the patient complained of leg numbness. Lumbar magnetic resonance imaging revealed spondylodiscitis of L3-4 and S1 (Figure 3). After 6 weeks of treatment with levofloxacin, the pulmonary lesions regressed. The patient refused surgery for spondylodiscitis.

FIGURE 1:
Coronal reformatted chest CT shows peripherally distributed nodules with or without cavitation (open yellow arrows).

FIGURE 2:
Axial chest CT shows cavitary subpleural nodules (open yellow arrows) and residual pneumothorax (open red arrow).

FIGURE 3:
Contrast-enhanced T1-weighted fat saturated magnetic resonance imaging shows L3-4 and S1 spondylodiscitis with epidural enhancement.

Septic pulmonary embolization is a rare condition that is difficult to diagnose due to nonspecific clinical and radiological findings. Indwelling catheters, drug abuse, and infective endocarditis are risk factors for this condition¹1. Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 2005;128(1):162-6.. The CT appearance of septic emboli includes well-defined peripherally located nodules with or without cavitation or wedge-shaped peripheral lesions²2. Iwasaki Y, Nagata K, Nakanishi M, Natuhara A, Harada H, Kubota Y, et al. Spiral CT findings in septic pulmonary emboli. Eur J Radiol 2001;37(3):190-4.. Feeding vessel signs were also observed.

Patients rarely present with spontaneous pneumothorax³3. Okabe M, Kasai K, Yokoo T. Pneumothorax secondary to septic pulmonary emboli in a long-term hemodialysis patient with psoas abscess. Intern Med 2017;56(23):3243-7.. In patients with spondylodiscitis and peripherally distributed cavitary nodules on CT scan, septic lung emboli should be suspected.

ACKNOWLEDGMENTS

The authors have no acknowledgments.

REFERENCES

¹
Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 2005;128(1):162-6.
²
Iwasaki Y, Nagata K, Nakanishi M, Natuhara A, Harada H, Kubota Y, et al. Spiral CT findings in septic pulmonary emboli. Eur J Radiol 2001;37(3):190-4.
³
Okabe M, Kasai K, Yokoo T. Pneumothorax secondary to septic pulmonary emboli in a long-term hemodialysis patient with psoas abscess. Intern Med 2017;56(23):3243-7.

Financial Support: The authors received no financial support for the research and/or authorship of this article.

Publication Dates

Publication in this collection
08 Apr 2022
Date of issue
2022

History

Received
26 Nov 2021
Accepted
04 Jan 2022

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 2005;128(1):162-6.

[2] ²
Iwasaki Y, Nagata K, Nakanishi M, Natuhara A, Harada H, Kubota Y, et al. Spiral CT findings in septic pulmonary emboli. Eur J Radiol 2001;37(3):190-4.

[3] ³
Okabe M, Kasai K, Yokoo T. Pneumothorax secondary to septic pulmonary emboli in a long-term hemodialysis patient with psoas abscess. Intern Med 2017;56(23):3243-7.

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