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Infectious Diseases

Recurrent back infection

10/13/2004

Question:

In March of 2000 I was treated through outpatient surgery for a dermoid cyst which was 3 inches deep and seriously infected. After several weeks of antibiotic treatment, and returning every few days for debriding, the surgery site had healed, and there was no longer any apparent infection. In September 2003 another similar cyst was removed a few centimeters from the original site. The surgeon would not prescribe antibiotics because he did not feel there was any risk of infection. Within three days I had an obvious infection at the surgery site and my family practitioner prescribed anitbiotics and prednisone. After finishing the course of antibiotics and steroids I began to experience symptoms of increasing fatigue, breathlessness, and discomfort and pain due to lumps which developed in the tissues of my back (no longer tied to any kind of cyst site). These symptoms were often but not always accompanied by what most physcisians call low grade fever (99.2). These worsening symptoms culminated in December in two fainting episodes, one at home and one in the doctor`s office, for which I was sent to the hospital. In the ambulance my pressure spiked, then crashed after the administration of nitro. Several cardiac tests were done, but I was told that I had not had a MI, and nothing else cardiac showed. Since then I have had another fainting episode and several near fainting episodes. The painful lumps in my back respond to, but are not eliminated by, the administration of antibiotics. (The most recent was Ketek for fourteen days.) Within a week of ceasing anitbiotics the lumps begin to reappear, and the pain and difficulty breathing as well. I have a history of Rheumatic fever, strep throat, gangrenous gall-bladder, sinus and urinary tract infections, and a severe infection in my cervix which required a Leep procedure. I have had a CAT scan, and will be seeeing a neurologist about some abnormalities that have been detected in my parietal lobe. My family physician has ordered many tests (lung function, work), but nothing "abnormal" has been detected except on my CAT scan. Are you able to determine what kind of doctor I should be seeing, or what kind of infection (other?) I might be battling? Anything you could suggest would be welcome--both my doctor and I are baffled and frustrated.

Answer:

Your situation seems fairly complicated.  The symptoms date back a year and are not clearly infectious, despite the "low grade fever" and partial response to antibiotics.  In trying to focus on what is causing the "lumps"  I would suggest a CT scan of the area (I presume this is your low back), a sedimentation rate and C reactive protein level, and a white cell count.  A bone scan and an indium scan might also be of use.  It would be worthwhile seeing if any pathologic examination of the cysts were performed on either of the two previous surgeries or if any cultures were taken.  There are some unusual organisms in the AFB and fungal families which can cause smoldering infections.  If any of the above listed tests are suspicious for infection a consultation with an infectious diseases doctor may be of benefit.

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Response by:

Peter Grubbs, MD
Assistant Professor
College of Medicine
University of Cincinnati