PMC8182662_01
Non-typeable Haemophilus influenzae invasive spondylodiscitis started from a bacteremia of the ENT entry site and shows an unreported
mechanism of dissemination. (a) PET scan; other images show a continuous fixation along the iliopsoas muscle; (b, c) spine and pelvic T1-weighted gadolinium-enhanced MRI:  L4-L5
spondylodiscitis with epidural abscess;  right medial iliopsoas infiltration;   hip prosthesis infection. (d) Sinus T2-weighted MRI and (e) peri-operative view of endo-nasal surgery after opening the right ethmo-orbital mucocele: / mucocele revealed a
clear mucoid content that underwent Haemophilus influenzae-specific PCR, positive for a non-typeable strain. (a), (b), (c), and (d) are courtesy of the Radiology
Department of Gustave Dron Hospital.
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Ch1.F1
Nevertheless, fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (PET) scan showed intense fixations of the L4-L5 vertebras, the right iliopsoas (continuously as shown in other images), and right periprosthetic tissues (Fig. 1a), consistent with magnetic resonance imaging (MRI), which showed an iliopsoas infiltration and epidural abscess-associated spondylodiscitis (Fig. 1b and c). Sinus computerized tomography (CT) and MRI revealed a right ethmoido-orbital mucocele responsible for lysis of the medial orbital wall but not the anterior cranial fossa (Fig. 1d). To release the osteolytic pressure, allow bone reconstruction, and avoid further complications, naso-endoscopic surgery was performed (after a normal ophthalmologic examination was confirmed) through a mid-turbinate and opened mucocele (Fig. 1e).