Endocrine Abstracts

Background: During the COVID-19 outbreak, there are rising concerns about long-term complications of COVID-19. On the other hand, discitis is a rare neurologic diagnosis, often delayed or missed due to the rarity of the disease. Patients usually present at an average age of 69 years with a history of diabetes or with a systemic infection. The lumbar spine is the most frequent site of infection (54%), and the cervical is the least at 10%. This is a case of post-COVID-19, diabetic patient complicated by discitis after a lumbar puncture.

Case presentation: A 77 years old patient presented in our emergency unit with intermittent temperature, headache and nuchal rigidity. Medical history: Patient was diagnosed with Diabetes Mellitus and hypertension 5 years ago. He was being treated with Metformin and antihypertension drugs. He was diagnosed with COVID-19, two months ago, since then he has had temperature between 38-39°C. Laboratory analysis: hyperglycemia and hypoalbuminemia, in haemogram: microcytic hypochromic anemia and neutrophilic leukocytosis. CRP(C Reactive Protein) and D-dimer were very high (22 mg/dl and 4 times normal range respectively). Kidney, liver and thyroid gland function resulted normal. In cranio-thoracal CT: Large multinodular thyroid gland with calcified nodules that slightly compressed trachea. Head and thorax normal. A diagnostic lumbar punction was obtained but the result excluded meningitis. Because of disequilibrated diabetes and need for thyroid exploration, the patient was hospitalized in Endocrinology Department where insulin, antibiotics (ceftriaxone and moxifloxacine), anticoagulation therapy and human albumin were started. After being hospitalized he complained a severe lumbar pain. CRP firstly, started to fall but then started to raise (10 days later even on antibiotic therapy, CRP was 18 mg/dl again), and immediately CT and then MRI with contrast were performed and confirmed presence of L2-L3 spondylodiscitis. ASLO, C3, C4, RF, and tumoral markers were normal. Infectionist changed antibiotic therapy to Imipenem and Ciprofloxacine,10 days later, CPR level decreased to 6.6 mg/dl, but lumbar pain persisted even under painkiller. Sub febrile temperature kept persisting also. Our patient also achieved better glycemic control under basal-bolus insulin regimen but inflammatory parameters (PCR, D-dimer and Fibrinogen) remained high and actually he is transferred to local hospital for further treatment with intra venous antibiotics.

Conclusion: Post-covid-19 diabetic patients who are imunocompromised, are in higher risk of developing serious infections (like spondylodiscitis) even after diagnostic procedures like lumbar spine diagnostic puncture. Physicians must be careful to prevent.