Abstract
A 68-year-old woman on long-term glucocorticoid treatment for rheumatoid arthritis presented to our hospital with a chief complaint of palpitations. She was diagnosed with paroxysmal supraventricular tachycardia and received antiarrhythmic medication, without any increases in systolic blood pressure. A reassessment of her clinical condition revealed abdominal pain with signs of generalized peritonitis. Computed tomography detected ascites and an abscess on the anterior surface of the lower lumbar vertebrae and sacrum, suggestive of pyogenic spondylodiscitis. During emergency laparotomy, infectious ascites was present and the superior portion of the abscess had ruptured into the peritoneal cavity. The abscess was incised and drained. A broad-spectrum antibiotic and an agent to cover MRSA were administered since the patient was an immunocompromised host. After identifying the pathogen, Escherichia coli, the antibiotic regimen was tailored and continued for 4 weeks. She did not undergo any medical procedures prior to this event and had no symptoms of a urinary tract infection. We hypothesize that bacterial translocation from the gut resulted in bacteremia which seeded the pyogenic spondylodiscitis.
