A 57-year-old man with a history of hypertension and dyslipidaemia, with ischaemic heart disease and acute inferior myocardial infarction in 2004, peripheral artery disease with bifemoral aortic bypass in 2006, and acute ischaemia of the left lower limb in 2010 due to by-pass occlusion requiring urgent revascularisation with thrombectomy. He has been on haemodialysis since December 2010 due to chronic renal failure possibly secondary to nephroangiosclerosis.
After failure of the left radiocephalic AVF, a left jugular temporal catheter was placed at the end of August 2013, which was dysfunctional from the beginning but was maintained until the use of a new left humerus cephalic AVF.
One month after catheter placement, the patient occasionally reported postural low back pain to the nurse, although the patient himself attributed this to exertion.
After removal of the catheter (43 days after insertion), in several subsequent sessions he presented general malaise and fever, a bacteriological control of the monitor was carried out, which was negative, and vancomycin 1 g was administered empirically, together with an antipyretic, and the patient remained stable for the following month.
Subsequently, he again reported very intense lumbar pain that barely allowed him to ambulate. He went to the emergency department on up to four occasions and after examination, X-ray and abdominal ultrasound always diagnosed mechanical lumbago.
Given the deterioration of his general condition and after confirming analytical alterations (increased C-reactive protein and erythrocyte sedimentation rate), he was admitted to the internal medicine unit for further investigation. Following positive microbiological results for S. aureus, antibiotic treatment with cloxacillin was started. Following magnetic resonance imaging (MRI), a diagnosis of spondylodiscitis D10-D11 was made, associated with a paravertebral abscess that did not involve nerve structures.
Analgesic treatment was started with first level drugs associated with transdermal opioids, with progressive titration of doses throughout the hospital stay and acceptable pain control.
The patient remained afebrile throughout his admission, with a progressive decrease in acute phase reactants and negative blood cultures. He completed five weeks of targeted intravenous antibiotic treatment and was then transferred to outpatient oral therapy and discharged from hospital. At this time the patient remains stable without further intrahaemodialysis symptoms with analgesia controlled by the patient and awaiting new control MRI.