RESUMO
Vertebral osteomyelitis is a disc and vertebral infection that causes nonspecific symptoms such as back pain, fever, and weakness. The most common causative pathogen is Staphylococcus aureus, and Escherichia coli (E. coli) is an uncommon cause. An 88-year-old man presented to the emergency department with a fever and lower back pain. His blood cultures were persistently positive for E. coli on days one, three, and five, and a diagnosis of vertebral osteomyelitis was made after an MRI of the lumbar spine. It has been reported that infectious dissemination to the vertebrae may occur through Batson's venous plexus, which is a network of paravertebral veins, and the pelvic venous plexus. Clinicians should remember that vertebral osteomyelitis can be a cause of persistent bacteremia.
RESUMO
Background: Despite the possible occurrence of spontaneous movements during an apnea test, respiratory-like movements are rare. Case Presentation: A 51-year-old man was transferred to our hospital when a sudden disturbance of consciousness developed into cardiac arrest. After spontaneous circulation returned, we diagnosed bilateral cerebellar hemorrhage. He remained comatose with dilated pupils, absent brainstem reflexes, spontaneous breathing, and electrocerebral activity. After being considered brain dead, his family opted for organ donation. The first legal brain death examination on day 5 was aborted because of respiratory-like movements mimicking repetitive abdominal respiration during the apnea test. However, an enhanced magnetic resonance image of the head indicated no blood flow and somatosensory evoked potential testing revealed no brain-derived potentials. Conclusion: Respiratory-like movements can occur during the apnea test in patients considered brain dead. Further research is required to understand this phenomenon.