요추 골수염과 동반된 요추 신경근병증과 장요근의 화농근육염 - 증례보고 -
Comorbidity of Lumbar Radiculopathy and Iliopsoas Pyomyositis in Lumbar Vertebral Osteomyelitis: A Case Report
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Among the factors causing lower extremity weakness in patients with lumbar vertebral osteomyelitis (VO), comorbid lumbar radiculopathy and iliopsoas pyomyositis represent complex and mixed patterns of paralysis and may be difficult to diagnose. Here we report the case of a 64-year old female patient with lumbar VO at the level of the L3-4 vertebrae. She presented with lower back pain and paralysis of the left lower extremity rapidly progressed to MRC grade 2/5 in the hip flexor and knee extensor muscles. The EMG of iliopsoas pyomyositis demonstrated a pattern similar to that of inflammatory necrotizing myopathies: short duration, low amplitude, and polyphasic motor unit action potentials with florid fibrillation. Other EMG findings of acute L4 radiculopathy developed concomitantly, potentially due to direct compression of spinal nerve roots by lumbar epidural abscess and/or aggravation of the spinal lesions. This report demonstrates interesting diagnostic challenges for the diagnosis of lower extremity weakness during the progression of lumbar VO.
Abstract
Among the factors causing lower extremity weakness in patients with lumbar vertebral osteomyelitis (VO), comorbid lumbar radiculopathy and iliopsoas pyomyositis represent complex and mixed patterns of paralysis and may be difficult to diagnose. Here we report the case of a 64-year old female patient with lumbar VO at the level of the L3-4 vertebrae. She presented with lower back pain and paralysis of the left lower extremity rapidly progressed to MRC grade 2/5 in the hip flexor and knee extensor muscles. The EMG of iliopsoas pyomyositis demonstrated a pattern similar to that of inflammatory necrotizing myopathies: short duration, low amplitude, and polyphasic motor unit action potentials with florid fibrillation. Other EMG findings of acute L4 radiculopathy developed concomitantly, potentially due to direct compression of spinal nerve roots by lumbar epidural abscess and/or aggravation of the spinal lesions. This report demonstrates interesting diagnostic challenges for the diagnosis of lower extremity weakness during the progression of lumbar VO.
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