Pseudomonas aeruginosa costovertebral arthritis in association with spontaneous cervical spondylodiscitis and epidural abscesses in the elderly

Cervical spondylodiscitis is an uncommon skeletal infection and its association with Pseudomonas aeruginosa has only been described in isolated case reports. Causes of cervical spondylodiscitis in these patients have been identified, except for the present case. A man aged 78 years with no significant previous medical history presented with an 8-week history of cervical pain and bilateral C5-7 radiculopathy. Magnetic resonance imaging revealed epidural abscesses and the destruction of C7 and T1 vertebrae, the interposing disc, and bilateral costovertebral joints. P aeruginosa was grown from open biopsy tissues and intravenous antibiotics were then administered to treat the infection. At the end of the 12-month follow-up period, all presenting symptoms had resolved and inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) were within the normal ranges. Despite the infrequent incidence of cervical spondylodiscitis, it should be considered in elderly patients in whom risk factors are not found but unrelenting neck or back pain is reported.