Spondylodiscitis in pediatric age – a rare disease, a difficult diagnosis

Keywords: spondylodiscitis, osteoarticular infection, pediatrics

Abstract

Introduction and objective: spondylodiscitis is an infection that affects the intervertebral disc and the contiguous vertebrae. It represents two to four % of all osteoarticular infections in pediatric age. The pathogen is identified in about half of the cases, with Staphylococcus aureus being the most frequently isolated. Recent studies show that between six months and four years, Kingella kingae has an important etiological role. The purpose of the presentation of this clinical case was to draw attention to this rare pathology whose diagnosis is difficult and requires a high level of suspicion.
Clinical case description: a sixteen-month-old male, with a history of constipation, is brought multiple times to the Pediatric Emergency Department for a clinical picture with more than a month of evolution of persistent irritability, abdominal pain and refusal to walk, with progressive worsening. On the second visit to the Pediatric Emergency Department, he presented dorsolombalgia on palpation of the dorsolumbar spine and decreased lumbar lordosis, which led to the performance of analytical evaluation, urinalysis, renal and bladder ultrasound and dorsolumbar radiography, all without changes. On the third visit to the Pediatric Emergency Department, hospitalization was decided and dorsolumbar nuclear magnetic resonance and bone scintigraphy were requested, revealing spondylodiscitis in D7-D8. Analytical parameters had no changes, except for a slight increase in erythrocyte sedimentation rate. Blood cultures and remaining etiological study negatives. Intravenous therapy with cefuroxime and flucloxacillin was started with progressive improvement of pain. Upon discharge he was asymptomatic and maintained oral flucloxacillin until a total of six weeks of treatment. He was subsequently reassessed and remained asymptomatic, with a physical examination, analytical evaluation and dorsolumbar radiography without changes.
Conclusions: spondylodiscitis is an identity that is difficult to diagnose, especially in children, due to its rarity, unspecific clinic, inability for children to verbalize their symptoms and late radiologic signs, requiring a high index of suspicion. The average time between the onset of symptoms and the diagnosis is three weeks to three months. Magnetic resonance imaging is the exam of choice. Blood cultures are often negative. The mainstay of treatment is antibiotic therapy for several weeks, but its choice and duration are controversial. Inappropriate treatment can lead to chronic pain, severe orthopaedic sequelae and devastating neurological complications. When timely and properly treated, most cases have a benign and self-limited clinical course.

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Author Biographies

Madalena Meira Nisa, Centro Hospitalar Tondela-Viseu (CHTV), Serviço de Pediatria, Viseu, Portugal.

Mestrado Integrado em Medicina pela Nova Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa. Interna de Formação Específica de Pediatria no Centro Hospitalar Tondela-Viseu (EPE/ CHTV), em Viseu, Portugal.

Jessica Sousa, Centro Hospitalar Tondela-Viseu (CHTV), Serviço de Pediatria, Viseu, Portugal.

Mestrado Integrado em Medicina pela Faculdade de Medicina, pela Univerdade de Lisboa. Interna de Formação Específica de Pediatria no Centro Hospitalar Tondela-Viseu (EPE/CHTV), em Viseu, Portugal.

Joana Pimenta, Centro Hospitalar Tondela-Viseu (CHTV), Serviço de Pediatria, Viseu, Portugal.

Mestrado Integrado em Medicina pela Faculdade de Medicina da Universidade de Coimbra. Assistente em Pediatria no Centro Hospitalar Tondela-Viseu (EPE/ CHTV), em Viseu, Portugal. Pós-graduada em Nutrição e Metabolismo em Pediatria pela Escola Superior de Tecnologia da Saúde de Coimbra. Pós-graduada em Cuidados Paliativos Pediátricos pela Universidade Católica Portuguesa.

Joaquina Antunes, Centro Hospitalar Tondela-Viseu (CHTV), Serviço de Pediatria, Viseu, Portugal.

Licenciatura em Medicina na Faculdade de Medicina da Universidade de Coimbra. Assistente em Pediatria no Centro Hospitalar Tondela-Viseu (EPE/ CHTV). Mestre em Urgências Pediátricas, 2ª Edição, pela Universidade Católica de Valência, Espanha.

Dora Gomes, Centro Hospitalar Tondela-Viseu (CHTV), Serviço de Pediatria, Viseu, Portugal.

Licenciatura em Medicina na Faculdade de Medicina da Universidade de Coimbra. Assistente em Pediatria no Centro Hospitalar Tondela-Viseu (EPE/CHTV), em Viseu, Portugal.

Cristina Faria, Centro Hospitalar Tondela-Viseu (CHTV), Serviço de Pediatria, Viseu, Portugal.

Licenciada em Medicina pela Faculdade de Medicina da Universidade de Coimbra. Assistente Graduada de Pediatria no Serviço de Pediatria do Centro Hospitalar Tondela Viseu (CHTV), em Viseu, Portugal.

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Published
2022-05-16
How to Cite
Nisa, M. M., Sousa, J., Pimenta, J., Antunes, J., Gomes, D., & Faria, C. (2022). Spondylodiscitis in pediatric age – a rare disease, a difficult diagnosis. Scientia Medica, 32(1), e41086. https://doi.org/10.15448/1980-6108.2022.1.41086