A 78-year-old patient with a history of arterial hypertension, type 2 diabetes mellitus, osteoporosis and repeated nephritic colic who 6 days before admission began with pain in the right renal fossa with irradiation to the ipsilateral knee, which was treated as an outpatient with dexametaxone, lidocaine, cyanocobalamin and thiamine without resolution. Subsequently, the patient began to feel dystrophic with thermometric temperature above 38ºC, poor general condition, urinary symptoms and glycaemic decompensation, for which he was admitted to hospital.
Physical examination revealed marked general malaise, fever, pain in the sacral area with negative bilateral percussion fist and knees with signs of phlogosis.
Laboratory tests showed mild leukocytosis without left shift (12,100x103/mm3 with N 65%), hyperbilirubinaemia with direct predominance (BT: 3.4 mg/dl, BD: 2.7mg/dl), alkaline phosphatase 215 U/L (35-104). The rest of the laboratory tests showed no significant alterations.
Complementary examinations included blood and urine cultures, joint fluid puncture and cultures, CT scan of the abdominal and lumbosacral spine, magnetic resonance imaging of the lumbar spine and scintigraphy with Ga-67/MDP-Tc-99.
The CT scan of the abdominal and lumbosacral spine shows air densities in the lumbar and right psoas muscles and in the intraspinal and dorsal location. Gas is also seen in the bony canal, which could correspond to a ruptured L4-L5 disc.

The MRI of the lumbar spine confirmed images compatible with abscesses in the right paravertebral and psoas muscles, and two collections suggesting epidural abscesses located at L4-L5 and D12-L4. An alteration of the signal of the body of D12 was observed after administration of gadolinium, resulting in bone oedema compatible with spondylitis and probable spondylodiscitis.

In the combined body scan with Ga-67/MDP-Tc-99M there was pathological hyperfixation of both tracers in knees and shoulders suggesting an inflammatory-infectious process as well as greatly increased gallium uptake at L4-L5 and in paravertebral soft tissues compatible with spondylodiscitis with possible infection of adjacent soft tissues.
On admission, empirical antibiotic treatment was started with ciprofloxacin, with subsequent microbiological confirmation (blood, urine and joint fluid cultures) of the presence of Escherichia coli, with a similar antibiogram.
During the first few days of treatment, the patient's symptoms improved slightly, coinciding with the introduction of antibiotics and antipyretics. On the 10th day of admission, the fever reappeared and the general condition progressively worsened. On the 12th day of admission, the patient presented atrial fibrillation with rapid ventricular response and cardiorespiratory arrest without response to resuscitation manoeuvres.
The diagnosis was E. coli urinary tract infection complicated by polyarticular septic arthritis, spondylodiscitis, epidural abscesses, psoas and dorso-lumbar musculature.