A Case Report of Colon Cancer Presenting with Pseudomonas Vertebral Pyogenic Spondylodiscitis and Bacteremia

Abstract

A 72-year-old man visited another hospital with back pain. Since the back pain increased, he was referred to our emergency outpatient department. Contrast-enhanced computed tomography (CT) in the emergency department showed pyogenic spondylitis in the lumbar 4/5 intervertebral spaces, a generalized descending colon cancer, and a chronic dissecting thoracic aortic aneurysm (Stanford type B). In addition, Pseudomonas aeruginosa was detected in the arterial blood culture on the day of admission, which led to the diagnosis of vertebral pyogenic spondylodiscitis (VPSD) due to hematogenous infection from colon cancer. With fasting and bed rest, pain control, proper blood pressure control with antihypertensive agents, and intravenous antibiotics, the patient underwent complete endovascular surgery on the 20^th day of hospitalization and emergency decompression with transanal ileus tube insertion on the 26^th day of hospitalization. The surgery was divided into three phases. The patient progressed well after the 5th operation. Curative resection was performed for the colorectal cancer, and the VPSD was cured by antibiotic treatment without any sequelae. The patient is now living well one year after the last operation.

A rare case of VPSD caused by Pseudomonas aeruginosa with advanced colorectal cancer as a prior infection is reported, along with a discussion of the mechanism of infection by a review of reported cases.