Destructive spondyloarthropathy mimicking infectious spondylitis in long-term hemodialysis patients: a two-case report with contrasting outcomes

Abstract

Abstract Destructive spondyloarthropathy (DSA) is a rare complication of long-term hemodialysis that often mimics infectious spondylitis, making diagnosis challenging. We report two patients with chronic kidney disease on long-term hemodialysis who presented with progressive neurological deficits and destructive spinal lesions suggestive of infection. In both cases, percutaneous biopsy of the lumbar destructive lesions showed no definitive evidence of infection, although occult infection could not be completely excluded. A 56-year-old woman underwent cervical reconstruction and achieved significant neurological recovery with solid fusion at 24 months. In contrast, a 62-year-old man underwent lumbar reconstruction but developed severe postoperative wound complications and died following a fatal cardiac event. These cases highlight the importance of considering DSA in the differential diagnosis of destructive spinal lesions in hemodialysis patients. Histological confirmation is essential before definitive treatment, and surgical outcomes depend not only on technical success but also on the patient's systemic condition and comorbidities.