Images in a patient on chronic haemodialysis with low back pain and Staphylococcus septicaemia
- Lin-Nei Hsu1,
- Huey-Liang Kuo2,
- Shu-Ming Wang1,
- Jiung-Hsiun Liu2,
- Yao-Lung Liu2,
- Che-Yi Chou1,
- Chiu-Ching Huang2
- 1China Medical University Hospital, Internal Medicine, No. 2 Yude Road, North District, Taichung, 40461, Taiwan
- 2China Medical University Hospital, No. 2 Yude Road, Taichung, 40461, Taiwan
- Che-Yi Chou,
- Published 10 August 2009
A 47-year-old man with history of alcoholic liver cirrhosis (Child–Pugh class C) and end stage renal disease was admitted because of bilateral flank pain for 2 weeks. He started haemodialysis (HD) via left femoral double lumen because of hyperkalaemia 1 month before admission. He denied a history of muscle strain or trauma and his low back pain got worse while bending forward. He also had intermittent low-grade fever. Physical examination revealed left flank knocking tenderness. His white blood cell count was 10.43×103 cells/μl and C-reactive protein was 18.92 mg/dl. An abdominal CT scan showed focal abscesses from the left diaphragm to the left psoas muscle (fig 1). The blood culture revealed methicillin-resistant Staphylococcus aureus septicaemia. Study of a transoesophageal echocardiogram showed no vegetation and the findings of an osteomyelitis scan were unremarkable. His low back pain resolved 2 weeks later after treatment with vancomycin and rifampicin. The follow-up abdominal CT scan showed a resolution of the psoas muscle abscess (fig 2).
S aureus is one of the most common causes of infection1 and low back pain is a common symptom in patients on chronic HD.2 The causes of low back pain in patients on chronic HD include nerve root compression, injury muscles, ligaments and joints; cauda equina syndrome, infection and tumours. Psoas abscess in patients on HD could be caused the contiguous vascular access device such as a femoral double lumen.3 Clinical history and physical examination are the key factors for diagnosis.
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.