Case 11: Could This Be Guillain-Barré Syndrome?

Dana Cummings, MD, PhDPreceptor: Thomas Crawford, MD

Disclosures

February 22, 2002

In This Article

Discitis

Discitis, a self-limiting inflammation or infection of the intervertebral disk space or vertebral endplates,[3] is often one of the differential diagnoses in young children who present with refusal to walk. It occurs primarily in children but can be seen in adults, especially in the postsurgical setting.[4]

Discitis typically is recognized by the following triad: disk-space narrowing, elevated ESR, and fever. The bone scan typically shows increased uptake of technetium 99m (Tc-99m) diphosphonate in vertebrae contiguous with the affected disk. Occasionally protrusion of the inflamed disk into the spinal canal can produce neurologic signs.

Clinical presentation. The majority of children who develop discitis are younger than 3 years of age. The typical clinical presentation includes irritability, a limp, and refusal to sit, stand, or walk. They may present after 2-4 weeks of symptoms. Older children may complain of diffuse back pain.[4] In one study, only 50% of patients had localized pain of the lumbar spine.[3]

Etiology. The most likely cause of discitis is transient bacteremia-related seeding of vascular channels in the cartilaginous region of the discs, which disappear later in life.[4]

Laboratory findings. The ESR is almost always elevated, blood cultures are rarely positive, and the CBC and differential are usually unremarkable.[3]

Radiologic findings. Radiologic studies may be normal during the first 1-2 weeks, but by 3 weeks one sees narrowing of the intervertebral disc space, most often at L3-4 or L4-L5. By 4-8 weeks, some erosion of adjacent vertebral plates and ballooning of the disk is visible. Nuclear medicine scans often show increased activity in the adjacent vertebrae.[4]

In children aged 3 years and younger, discitis is much more common than osteomyelitis.[5] Fever and ill appearance are much more common in those with osteomyelitis. Magnetic resonance imaging (MRI) will discriminate between discitis and osteomyelitis.

Management of discitis requires immobilization with splinting or casting. Antibiotics have not been shown to change the natural history of a single episode of discitis, but antibiotic treatment might reduce the risk of recurrence.[3]

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