Spondylodiscitis associated with multiple level involvement and negative microbiological tests: an unusual case.

Abstract

STUDY DESIGN:

A case report.

OBJECTIVE:

To report an unusual case of spondylodiscitis with multiple level involvement.

SUMMARY OF BACKGROUND DATA:

Spondylodiscitis, an infection of the intervertebral disc space, vertebral bodies, or the paraspinal epidural space can be a serious disease because of diagnostic delay and inadequate treatment.

METHODS:

A previously healthy, 52-year-old man was presented to our outpatient clinic with a complaint of acute, atraumatic onset of severe back pain for more than 1 month. Initially, he was misdiagnosed at another clinic as myofascial pain and treated with nonsteroidal anti-inflammatories and physical therapy, which he did not benefit from. He never complained of fever; however, laboratory tests revealed raised erythrocyte sedimentation values, increased C-reactive protein values but normal leukocyte count. Thoracal and lumbal plain radiographs were nonspecific. Magnetic resonance imaging demonstrated increased signal intensity in vertebral bodies and intervertebral disc space through T12-L4 and in the paravertebral musculature at L2-L3 with contrast enhancement. Blood cultures and computed tomography-guided needle biopsy and cultures were negative.

RESULTS:

The patient was treated with oral amoxicillin and clavulanate and responded very well clinically; however, imaging examinations were repeated up to 6 months because of multilevel involvement. Follow-up magnetic resonance imaging findings at 3 months and 6 months showed decreased signal intensity, and luckily, there was no evidence of vertebral destruction.

CONCLUSION:

Diagnosis of spondylodiscitis could be challenging and commonly missed; however, it should always be included in the differential diagnoses of back pain in the middle aged and healthy population.

• Authors: Oya Umit Yemisci, Sacide Nur Saracgil Cosar, Pnar Oztop, Metin Karatas
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 35 Issue 19 Pg. E1006-9 (Sep 01 2010) ISSN: 1528-1159 [Electronic] United States
• PMID: 20395882 (Publication Type: Case Reports, Journal Article)

Chemical References

• Biomarkers
• Amoxicillin-Potassium Clavulanate Combination
• C-Reactive Protein

Topics

• Administration, Oral
• Amoxicillin-Potassium Clavulanate Combination (administration & dosage)
• Back Pain (microbiology)
• Biomarkers (blood)
• Biopsy
• Blood Sedimentation
• C-Reactive Protein (analysis)
• Discitis (blood, diagnosis, microbiology, pathology)
• Humans
• Leukocyte Count
• Lumbar Vertebrae (pathology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Severity of Illness Index
• Thoracic Vertebrae (pathology)
• Tomography, X-Ray Computed
• Treatment Outcome