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Spondylitis following Weil's Disease

1951; BMJ; Volume: 10; Issue: 1 Linguagem: Inglês

10.1136/ard.10.1.61

1468-2060

J. H. Jacobs,

Hepatitis C virus research

Cases of infective spondylitis following typhoid, paratyphoid, undulant fever, and gonococcal and staphylococcal infections are well recorded, and Brailsford (1948) reports arthritis of the spine as a complication of most of the infectious diseases.Ashe and others (1941), in their review of the world's literature on Weil's disease, record meningitis, leptospiral endocarditis, peripheral neuritis, optic atrophy, and iridocyclitis as complications, but no case of spondylitis following this infection appears to have been reported.The early radiological changes occurring in infective spondylitis may be confined to narrowing of the intervertebral disk spaces and osteoporosis of the neighbouring bone.This is later followed by loss of bony detail, small marginal erosions, and sclerosis of the opposing surfaces of the bodies, with bridging between them and possibly ultimate fusion of the vertebrae.Paravertebral abscesses may also be present. Case HistoryA man, aged 59, a plumber by trade, was admitted to hospital on 13 April, 1949, with a history of lassitude and shivering attacks for a week, and jaundice for the last two days.He stated that he had been working in a rat-infested factory until a week before admission.Examination revealed a febrile, drowsy, dehydrated, jaundiced man with purpuric spots on his trunk.A clinical diagnosis of sub-acute hepatic necrosis was made.Blood Examination.-White-cellcount 13,300; agglutinations positive to Leptospira icterohaemorrhagica to 1: 1,000, but negative to L. canicola.Three weeks later, white-cell count 25,000; agglutinations positive to L. icterohaemorrhagica to 1: 3,000, and positive to L. canicola up to a titre of 1: 300.Agglutinations positive to B. typhosus H. to 1: 50, but negative to B. typhosus 0, B. para- typhosus A and B, and Brucella abortus.Treatment.-He was treated with penicillin and improved after a slow and stormy course, but discharged himself from hospital on May 30, although still unable to walk.He does not remember suffering from pain in his back while in hospital, although an x ray of his spine taken on May 12, 1949, showed some osteo-arthritic changes in the mid- dorsal region and no other abnormality.Later Developments.-Afterreturning home he complained of pain across his back on attempting to get up, and he remained bed-ridden until November 16, 1949, when he was seen in the Rheumatic Unit and admitted to the wards.61