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

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2010-09, Vol.35 (19), p.E1006-E1009
• Main Authors: Yemisci, Oya Umit, Cosar, Sacide Nur Saracgil, Oztop, Pnar, Karatas, Metin
• Format: Article
• Language: English
• Subjects: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination - administration & dosage; Back Pain - microbiology; Biomarkers - blood; Biopsy; Blood Sedimentation; C-Reactive Protein - analysis; Discitis - blood; Discitis - diagnosis; Discitis - microbiology; Discitis - 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
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181c52d56

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