Discitis as an uncommon complication of metastatic colon cancer

Background: Liver metastasis from colon cancer is relatively often found in the follow-up period, too. If there is no good peripheral vein access it is not uncommon that chemotherapy is delivered through trough a central venous line. In such cases serious infectious complications may develop. Case report: Multiple liver metastases were detected by CT scan in a 57 year old diabetic man who had a left sided hemicolectomy two months earlier, because of sigmoid colon cancer. Cytostatic therapy (FU/FA) was only possible through central venous line. After three months of therapy endocarditis developed, so the catheter was removed. Staphylococcus aureus was isolated from blood cultures. The patient's blood cultures became negative after three weeks of antibiotic therapy but several serious low back pain appeared, causing inability to walk. On L-S spine and abdominal CT scan no abnormalities were revealed except the liver metastases. Spine MRI showed L.V.-S.I. discitis and inflammation of the ligaments from vertebrae L.IV. to S. II. narrowing the spinal canal, too. He was operated on and vertebral fixation was applied.

Conclusions: Not all complaints of a patient on cytostatic therapy are caused by metastasing cancer. Central venous line is not the best choice for chemotherapy in a diabetic patient. Discitis is a rare and perhaps underestimated disorder, with poor and almost no typical signs, but in cases with back pain, it should be taken into consideration. It can be also a differential diagnostic question for the gastroenterologists. Neither X-ray, nor CT scan, but only MRI is the proper diagnostic tool for discitis.