| Comorbidity of Lumbar Radiculopathy and Iliopsoas Pyomyositis in Lumbar Vertebral Osteomyelitis: A Case Report |
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Received: 11 October 2017 • Revised: 9 November 2017 • Accepted: 29 November 2017 |
| Abstract |
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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. |
| Key Words:
vertebral osteomyelitis, iliopsoas pyomyositis, lumbar radiculopathy |
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