Septic Discitis: An Important Cause of Back Pain

Prakashchandra Patel, MD, Kenneth E. Olive, MD, Koyamangalath Krishnan, MD

Disclosures

South Med J. 2003;96(7) 

In This Article

Abstract and Introduction

Abstract

A 65-year-old man with a 3-month history of intractable back pain had previously received cytotoxic curative chemotherapy for non-Hodgkin's lymphoma. His postchemotherapy course had been complicated by febrile neutropenia, recurrent coagulase-negative staphylococcal bacteremia, and gastrostomy site infections. He was admitted with severe intractable lower back pain requiring high doses of intravenous narcotic analgesia. Magnetic resonance imaging of the spine was highly suggestive of disk infection. Fluoroscopically guided needle aspiration of the disk space was confirmatory, and both tissue and blood cultures were positive for coagulase-negative Staphylococcus species. Treatment included IV vancomycin and oral levofloxacin. The most common organism causing disk space infection is Staphylococcus aureus, but Staphylococcus epidermis should be considered in immunocompromised patients. Septic discitis is an important differential diagnosis of back pain and should be considered in any clinical situation associated with bacteremia.

Introduction

Septic discitis is a rare cause of back pain, accounting for less than 0.01% of cases in the primary care setting.[1] It has been associated with a high morbidity and mortality in the past. The prognosis has improved in recent years with the use of sensitive new diagnostic techniques and antimicrobial treatment. Successful management of spinal infection includes a high level of suspicion to avoid delay in the diagnosis, institution of proper antibiotic therapy, and timely surgical intervention.[2] We present a case of low back pain as a result of septic discitis and discuss the systematic approach for the diagnosis and treatment.

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