Pyogenic Spondylitis and Psoas Abscess in a Patient with Diabetic Ulcer

A 67-year-old man with insulin-treated diabetes mellitus developed a diabetic ulcer on his right sole. He was admitted to our hospital on October 15, 2001 with high-grade fever and severe pain in his lower back and right lower leg. Bacteriological examination of the patient's blood and ulcer confirmed Methicillin-resistant Staphylococcus aureus, and vancomycin was administered. However, the patient's general condition did not improve, and his back and leg pain worsened. On day 4 after admission, computed tomography showed a low density mass around the psoas muscles, indicating a psoas abscess and magnetic resonance imaging showed pyogenic spondylitis of the lumber spine at L4/5. We performed drainage under general anesthesia but paralysis of the patient's lower limbs persisted. Diagnosis of pyogenic spondylitis and psoas abscess in patients with atypical clinical findings is difficult. Therefore, patients with diabetes mellitus should be routinely assessed for potential pyogenic diseases such as pyogenic spondylitis and psoas abscess.