J Korean Neurosurg Soc.  2019 Jul;62(4):487-491. 10.3340/jkns.2018.0052.

Antibiotic-Induced Increase in Inflammatory Markers in Cured Infectious Spondylitis: Two Case Reports

• Eom KS

• KMID: 2463680
• DOI: http://doi.org/10.3340/jkns.2018.0052

Abstract

Conservative therapy with appropriate antibiotics is essential for most patients with infectious spondylitis. Although most antibiotics do not cause problems if it used properly and serious side effects are rare, side effects can occur with any class of drugs and adverse reactions of antibiotics can range from mild allergic reactions to serious and fulminant adverse events. These side effects are also extremely variable from patient to patient and from antibiotic to antibiotic. A side effect of antibiotics may paradoxically increase inflammatory marker levels. Here, the author presents two cases of antibiotic-induced increase in inflammatory markers in cured infectious spondylitis. The patients were successfully treated after stopping the antibiotic therapy. The differential diagnosis between antibiotic side effects and infection should be considered very carefully because the treatment is completely different. Although the exact mechanisms underlying successful treatment without antibiotics are unclear, we should consider the side effects of antibiotics when following inflammatory markers during treatment of infectious spondylitis.

Keyword

Antibiotics; Spondylitis; Inflammation; Infection

MeSH Terms

Anti-Bacterial Agents
Diagnosis, Differential
Humans
Hypersensitivity
Inflammation
Spondylitis*
Anti-Bacterial Agents

Figure

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  Fig. 1. Case 1. A : Lumbar coronal contrast-enhanced CT showing postoperative infection with abscess formation along the screw heads and rods (black arrow) before antibiotics therapy. B : CT obtained after antibiotic therapy for 2 months showing complete disappearance of abscess. C : The course of inflammatory markers with ESR and CRP, BT, and eosinophil. ESR : erythrocyte sedimentation rate, CRP : C-reactive protein, BT : body temperature, POD : postoperative day, CT : computed tomography.

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  Fig. 2. Case 2. A : Sagittal fat-suppressed T2-weighted image showing infectious spondylitis at L4 and L5. B : A three-phase bone scan shows active spondylodiscitis at L4 and L5.

Reference

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