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John A. D'Elia, MD; Ramachandiran Cooppan, MD; Donna Younger, MD; S. Schoenbaum, MD; S. Freidberg, MD
Joslin Clinic Boston

JAMA. 1979;241(1):29.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Drs Parker and Tuazon have succinctly described two patients with vertebral osteomyelitis acquired in association with chronic hemodialysis (240:50, 1978). Other reports have suggested urinary tract disease,¹ intravenous drug abuse,² and indwelling intravenous catheters³ as the route of entry.

In a review of our experience with vertebral osteomyelitis among insulin-dependent diabetics,⁴ we uncovered only one with chronic bacteriuria and one with prior osteomyelitis as potential portals of entry. Subsequently, we have observed vertebral osteomyelitis in an immunosuppressed patient following successful renal transplantation at a time when glucocorticoid-induced diabetes had developed. We have not found vertebral osteomyelitis in our dialysis patients.

Thus, we would emphasize the importance of underlying systemic disease in predisposition to vertebral osteomyelitis, as well as the probability of an increased incidence with the use of immunosuppressive drugs. The absence of an obvious portal of entry reinforces the concept of a diagnostic . . . [Full Text PDF of this Article]

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