Primary Septic Costotransverse Arthritis with Secondary Destructive Osteomyelitis and Paraspinal Abscess: A Case Report and Review of Literature

The sequelae of spinal infection are insidious and, notably, may result in deleterious complications, including pain, instability, deformity, neurologic deficit, and/or death. The location of spinal infections can vary anatomically—from the vertebral body to the intervertebral disc or epidural space. Within the thoracic spine, the costovertebral and costotransverse joints are not typical loci of spinal infections. Herein, we report the case of a 46-year-old female with 1 week of subjective fevers and worsening cough with associated pleuritic chest pain and a presumptive diagnosis of MRSA pneumonia. Despite parenteral antibiotic treatment, the patient demonstrated no clinical improvement and subsequent imaging revealed a primary septic costovertebral arthritis, secondary destructive osteomyelitis, and associated paraspinal abscess. Surgical management, including resection of the affected costotransverse joint and debridement of the paraspinal abscesses, were required. To our knowledge, this is the second-ever reported case of primary septic costovertebral arthritis within the thoracic spine.