A case of non-insulin-dependent diabetes mellitus with vertebral osteomyelitits: usefulness of imaging diagnosis

Abstract

A 63-year-old woman with NIDDM poorly controlled by insulin therapy was admitted to our hospital because of fever and severe lumbago. Laboratory data revealed diabetic ketosis and a hypercoagulable state with infection. Bone and gallium scintigrams revealed an abnormal accumulation of the isotopes at L4-L5, where magnetic resonance imaging showed inflammatory changes. The patient was then diagnosed as having pyogenic vertebral osteomyelitis. Antibiotic chemotherapy and the administration of gebexate mesilate improved the inflammation and hypercoagulable state. When diabetic patients suffer from severe lumbago with sustained fever, and show segmental knock pain along the spine, pyogenic vertebral osteomyelitis should be considered. Bone and gallium scintigrams, and MRI are of clinical value for the early diagnosis of the disease.