ANTHIE DAMIANAKI (Greece)
National and Kapodistrian University, “P & A Kyriakou” Athens Children’s Hospital Second Department of PediatricsAuthor Of 1 Presentation
ADOLESCENT WITH PROGRESSIVE LOW BACKACHE
Abstract
Title of Case(s):
ADOLESCNT WITH PROGRESSIVE LOW BACKACHE
Background:
Spondylodiscitis in children and adolescents is rare. The condition has an incidence of 2-4% of all infectious skeletal diseases and is caused by haematogenous spread of pathogens with Staphylococcus aureus to be the most frequently detected bacterium.
Case Presentation Summary:
A Greek female adolescent was admitted to our Hospital due to back pain gradually deteriorated for the last five months with periodic episodes of low grade fever. From the personal history, a traumatic episode during intensive ballet training was reported the previous months. There were no gastrointestinal symptoms. Clinical examination revealed tenderness to palpation to lower lumbar area. Paraparesis and bowel-bladder dysfunction were not present. Blood testing revealed elevated inflammatory markers (max CRP 85mg/l and ESR 110mm/1hr). MRI study showed destruction of L1-L2 disc and involvement of paradiscal regions of L1 and L2 with para-vertebral collection at the same level. Blood cultures were negative. Tuberculosis, immunologic deficits and malignancies were ruled out by appropriate diagnostic procedures. A CT-guided needle biopsy was performed and Salmonella spp. was isolated from bone specimen. Despite the limited surgical exposure, our patient did not develop any complications, she remained neurologically intact and responded favourably to appropriate antibiotic therapy and spinal stabilization. We speculate that the cause of our patient’s spondylodiscitis was her mild spinal trauma secondary to the intensive training. Post-operatively a search was made for predisposing condition but tests were negative for any hemoglobinopathy. At final follow-up, the patient had resolution of back pain with full return to normal activity.
Key Learning Points:
Salmonella spondylodiscitis is a rare condition that is more prevalent in patients with sickle cell disease or immunosuppression. Although uncommon in immunocompetent patients and without any history of gastrointestinal symptoms or an origin from endemic area, salmonella spondylodiscitis should be considered in immunologically normal patients who have features of infective spondylodiscitis.
Presenter of 1 Presentation
ADOLESCENT WITH PROGRESSIVE LOW BACKACHE
Abstract
Title of Case(s):
ADOLESCNT WITH PROGRESSIVE LOW BACKACHE
Background:
Spondylodiscitis in children and adolescents is rare. The condition has an incidence of 2-4% of all infectious skeletal diseases and is caused by haematogenous spread of pathogens with Staphylococcus aureus to be the most frequently detected bacterium.
Case Presentation Summary:
A Greek female adolescent was admitted to our Hospital due to back pain gradually deteriorated for the last five months with periodic episodes of low grade fever. From the personal history, a traumatic episode during intensive ballet training was reported the previous months. There were no gastrointestinal symptoms. Clinical examination revealed tenderness to palpation to lower lumbar area. Paraparesis and bowel-bladder dysfunction were not present. Blood testing revealed elevated inflammatory markers (max CRP 85mg/l and ESR 110mm/1hr). MRI study showed destruction of L1-L2 disc and involvement of paradiscal regions of L1 and L2 with para-vertebral collection at the same level. Blood cultures were negative. Tuberculosis, immunologic deficits and malignancies were ruled out by appropriate diagnostic procedures. A CT-guided needle biopsy was performed and Salmonella spp. was isolated from bone specimen. Despite the limited surgical exposure, our patient did not develop any complications, she remained neurologically intact and responded favourably to appropriate antibiotic therapy and spinal stabilization. We speculate that the cause of our patient’s spondylodiscitis was her mild spinal trauma secondary to the intensive training. Post-operatively a search was made for predisposing condition but tests were negative for any hemoglobinopathy. At final follow-up, the patient had resolution of back pain with full return to normal activity.
Key Learning Points:
Salmonella spondylodiscitis is a rare condition that is more prevalent in patients with sickle cell disease or immunosuppression. Although uncommon in immunocompetent patients and without any history of gastrointestinal symptoms or an origin from endemic area, salmonella spondylodiscitis should be considered in immunologically normal patients who have features of infective spondylodiscitis.