Cases reported "Discitis"

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1/55. Anterior disc protrusion as a cause for abdominal symptoms in childhood discitis. A case report.

    STUDY DESIGN: A case report on infectious spondylitis in a child who reported abdominal pain and whose magnetic resonance image revealed anterior herniation of disc space contents. OBJECTIVES: To correlate the direction of disc protrusion in infectious spondylitis with clinical manifestations. SUMMARY OF BACKGROUND DATA: Previous studies have correlated posterior protrusion of disc space contents in infectious spondylitis with a clinical presentation of back pain, paravertebral muscle spasm, hamstrings tightness, and radiculopathy. None has connected anterior herniation of disc phlegmon with abdominal pain. methods: In addition to plain radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis of infectious spondylitis in a 6-year-old child with abdominal pain. Regular review for 1 year included repeat magnetic resonance imaging at 3 months. RESULTS: Initial magnetic resonance imaging revealed characteristic changes associated with infectious spondylitis throughout the L5-S1 vertebra-disc-vertebra unit and anterior protrusion of the disc material and phlegmon. magnetic resonance imaging at follow-up examination 3 months later demonstrated complete resolution of the disc herniation. CONCLUSION: Future magnetic resonance imaging studies should correlate direction of disc herniation with age and symptomatology to validate or improve classifications of infectious spondylitis, which presently include only the last two parameters.
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keywords = back pain, back
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2/55. Spondylodiscitis caused by viridans streptococci: three cases and a review of the literature.

    Three cases of spondylodiscitis caused by viridans streptococci were observed within the course of 1 month. Although streptococci have been reported as the third most frequent cause of spondylodiscitis after staphylococci and gram-negative bacteria, alpha-haemolytic streptococci are rarely seen. The three patients presented with symptoms of low back pain; they felt well and did not have a fever or chills. Laboratory examinations revealed inflammation. Further examinations such as scintigraphy, computed tomography or magnetic resonance imaging were done. Bacteriological diagnosis was established by blood cultures in two cases and by needle biopsy of the disco-vertebral space in one. In one patient endocarditis was also documented. Because the prevalence of endocarditis was found to be higher in our cases of spondylodiscitis due to Streptococcus viridans than for other bacteria, the exclusion of this diagnosis must be pursued aggressively. These observations lead us to question if the spectrum of bacteria causing spondylodiscitis is undergoing a change. an aetiological agent could be isolated in 1168 patients (85.4%): in 48% a staphylococcus, in 28% a gram-negative bacterium and in only 10% a streptococcus. There were two cases of viridans streptococci (0.2%). These two cases together with other single case reports [14-22] account for 15 cases of spondylodiscitis due to alpha-haemolytic streptococci. Differentiation of the organisms to the species level was accomplished in six cases: S. mitis (3), S. sanguis (2) and S. anginosus (1). Although a multitude of organisms, bacterial as well as fungal, causing spondylodiscitis has been reported in recent years, almost all were single cases [23-42]. The unusual observation of three cases of spondylodiscitis due to alpha-haemolytic streptococci within 1 month prompted us to review the clinical and laboratory findings and to compare these cases with those caused by staphylococcus aureus.
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keywords = back pain, back
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3/55. psoas abscess secondary to discitis: a case report of conservative management.

    We report a case of secondary psoas abscess in a 37-year-old man with a 3-week history of severe low backache managed conservatively without surgical drainage. Apart from bilaterally restricted straight leg raising (<70 degrees), his neurologic examination was within normal limits. magnetic resonance imaging showed discitis of the L3-L4 space and a left-sided secondary psoas abscess. Aspiration biopsy of the abscess material under radiologic control isolated staphylococcus aureus, which responded to appropriate antibiotic therapy with complete resolution. A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in patients with pyrexia and backache with a neurologic examination that is otherwise normal. We discuss the recommendations for surgical and nonsurgical approaches.
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keywords = back
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4/55. Spondylodiscitis associated with bacteraemia due to coagulase-negative staphylococci.

    Three cases are reported of spondylodiscitis caused by coagulase-negative staphylococci in patients without osteosynthetic material. All three patients had bacteraemia associated with an infected intravascular device left in place. On the basis of this observation, it is concluded that such devices should be removed promptly in cases of prolonged or relapsing bacteraemia. Furthermore, spondylodiscitis should be suspected in patients with back pain after bacteraemia caused by coagulase-negative staphylococci.
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5/55. enterobacter agglomerans spondylodiscitis: a possible, unrecognized complication of tetracycline therapy.

    STUDY DESIGN: This case report describes infection in a lumbar disc in a healthy young man with an organism of low pathogenicity. The patient was taking a prolonged course of antibiotics at the time the infection occurred. OBJECTIVE: To describe this unique case of infective spondylodiscitis. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, spinal infection with enterobacter agglomeranshas never been reported. This organism is a transient gut colonizer, and may have established itself secondary to the patient's prolonged ingestion of tetracycline for acne. methods: This 22-year-old farmer had spontaneous lumbar back pain. Radiologic investigations showed an abnormality in the L4-L5 disc region, and together with other investigations, were suggestive of infection. The diagnosis was confirmed by surgical aspiration. RESULTS: Antibiotic therapy was administered, and the patient made a complete recovery. Follow-up radiographs showed a complete loss of the L4-L5 disc space with only minimal bone destruction. CONCLUSION: A unique cause of infective lumbar discitis is presented. Several features of this case are unusual. The magnetic resonance findings were not readily diagnostic. The cultured organism is usually nonpathogenic. The infection may have been secondary to prolonged tetracycline therapy.
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keywords = back pain, back
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6/55. Infective discitis as an uncommon but important cause of back pain in older people.

    case reports: two elderly patients (aged 70 and 80 years) presented with severe back pain and restriction of spinal movements. Inflammatory markers were raised and in each case computed tomography findings confirmed infective discitis. One patient improved with antibiotics but the second developed paraplegia, a recognized complication of discitis. CONCLUSION: the association of back pain, restricted spinal movements and raised inflammatory markers should act as 'red flags', alerting the clinician to the presence of serious, but potentially treatable pathology.
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keywords = back pain, back
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7/55. Two cases of diskitis attributable to anaerobic bacteria in children.

    Diskitis, an inflammation of the intervertebral disk, is generally attributable to staphylococcus aureus and rarely staphylococcus epidermidis, kingella kingae, Enterobacteriaciae, and streptococcus pneumoniae. In many cases, no bacterial growth is obtained from infected intervertebral discs. Although anaerobic bacteria were recovered from adults with spondylodiscitis, these organisms were not reported before from children. The recovery of anaerobic bacteria in 2 children with diskitis is reported. Patient 1. A 10-year-old male presented with 6 weeks of low back pain and 2 weeks of low-grade fever and abdominal pain. physical examination was normal except for tenderness to percussion over the spine between thoracic vertebra 11 and lumbar vertebra 2. The patient had a temperature of 104 degrees F. Laboratory tests were within normal limits, except for erythrocyte sedimentation rate (ESR), which was 58 mm/hour. Blood culture showed no growth. magnetic resonance imaging with gadolinium contrast revealed minimal inflammatory changes in the 12th thoracic vertebra/first lumbar vertebra disk. There was no other abnormality. A computed tomography (CT)-guided aspiration of the disk space yielded bloody material, which was sent for aerobic and anaerobic cultures. Gram stain showed numerous white blood cells and gram-positive cocci in chains. Cultures for anaerobic bacteria yielded heavy growth of peptostreptococcus magnus, which was susceptible to penicillin, clindamycin, and vancomycin. The patient was treated with intravenous penicillin 600 000 units every 6 hours for 3 weeks, and then oral amoxicillin, 500 mg every 6 hours for 3 weeks. The back pain resolved within 2 weeks, and the ESR returned to normal at the end of therapy. Follow-up for 3 years showed complete resolution of the infection. Patient 2. An 8-year-old boy presented with low back pain and low-grade fever, irritability, and general malaise for 10 days. He had had an upper respiratory tract infection with sore throat 27 days earlier, for which he received no therapy. The patient had a temperature of 102 degrees F, and physical examination was normal except for tenderness to percussion over the spine between the second and fourth lumbar vertebrae. Laboratory tests were normal, except for the ESR (42 mm/hour). Radiographs of the spine showed narrowing of the third to fourth lumbar vertebra disk space and irregularity of the margins of the vertebral endplates. A CT scan revealed a lytic bone lesion at lumbar vertebra 4, and bone scan showed an increase uptake of (99m)technetium at the third to fourth lumbar vertebra disk space. CT-guided aspiration of the disk space yielded cloudy nonfoul-smelling material, which was sent for aerobic and anaerobic cultures. Gram stain showed numerous white blood cells and fusiform Gram-negative bacilli. Anaerobic culture grew light growth of fusobacterium nucleatum. The organism produced beta-lactamase and was susceptible to ticarcillin-clavulanate, clindamycin, metronidazole, and imipenem. Therapy with clindamycin 450 mg every 8 hours was given parenterally for 3 weeks and orally for 3 weeks. Back pain resolved within 2 weeks. A 2-year follow-up showed complete resolution and no recurrence. This report describes, for the first time, the isolation of anaerobic bacteria from children with diskitis. The lack of their recovery in previous reports and the absence of bacterial growth in over two third of these studies may be caused by the use of improper methods for their collection, transportation, and cultivation. Proper choice of antimicrobial therapy for diskitis can be accomplished only by identification of the causative organisms and its antimicrobial susceptibility. This is of particular importance in infections caused by anaerobic bacteria that are often resistant to antimicrobials used to empirically treat diskitis. This was the case in our second patient, who was infected by F nucleatum, which was resistant to beta-lactam antibiotics. The origin of the anaerobic bacteria causing the infection in our patient is probably of endogenous nature. The presence of abdominal pain in the first child may have been attributable to a subclinical abdominal pathothology. The preceding pharyngitis in the second patient may have been associated with a potential hematogenous spread of F nucleatum. P magnus has been associated with bone and joint infections. This report highlights the importance of obtaining disk space culture for aerobic and anaerobic bacteria from all children with diskitis. Future prospective studies are warranted to elucidate the role of anaerobic bacteria in diskitis in children.
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ranking = 3.0000751032817
keywords = back pain, back, upper
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8/55. Ankylosing spondylitis presenting with discitis.

    Ankylosing spondylitis is not an uncommon disease worldwide, yet is relatively rare in bahrain. There is a typical pattern of joint involvement in cases of ankylosing spondylitis, but the presentation of discitis is rare. We present a case of a patient presenting with backache and was diagnosed to have discitis. The diagnosis of ankylosing spondylitis was made only after he was found to be Human Leukocyte Antigen-B27 positive. This is the first case report of ankylosing spondylitis presenting as discitis in bahrain.
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ranking = 0.046123935844583
keywords = back
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9/55. Spondylodiscitis due to candida tropicalis as a cause of inflammatory back pain.

    Spondylodiscitis may be either infectious or rheumatic in origin. In the latter case it may be seen more often in the context of spondyloarthropathies, giving rise to inflammatory back pain. We report the case of a man, affected by ulcerative colitis and carcinoma of the colon, who developed spondylodiscitis due to infection by candida tropicalis.
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keywords = back pain, back
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10/55. discitis associated with pregnancy and spinal anesthesia.

    discitis (inflammation of the intervertebral disk) most commonly develops as a rare complication of bacterial infection or chemical or mechanical irritation during spine surgery (1) with a postoperative incidence of 1%-2.8% (2). It is also a complication of discography-the intradiscal injection of saline or contrast material (3). The incidence of postdiscography discitis is 1%-4% (3); no cases have been reported when prophylactic antibiotics have been used, supporting the theory of bacterial contamination (3). Although it is controversial whether discitis can be caused by an aseptic or infectious process, recent data suggest that persistent discitis is almost always bacterial (4). Honan et al. (5) reported 16 cases of spontaneous discitis and reviewed another 52 patients from the literature. In their series, patients tended to have one or more comorbid conditions, such as diabetes, vertebral fracture, or a preexisting spine injury. Spontaneous discitis has also been associated with advanced age, IV drug abuse, IV access contamination, urinary tract infection, and immunocompromised states (5,6). No cases of infectious discitis associated with pregnancy and spinal anesthesia have been reported in the English literature. discitis presents as spasmodic pain in the back that may be referred to the hips or groin (7). The pain may radiate to the lower extremities. The erythrocyte sedimentation rate is usually increased. Radiological changes in discitis include narrowing of the intervertebral disk space, vertebral sclerosis, and erosion of the end plates. The best diagnostic measure may be magnetic resonance imaging (MRI) or a combination of bone and gallium scanning (2). The mainstay for discitis treatment is pain control and antibiotics; surgical intervention is usually not required. Complications of discitis include intervertebral fusion, epidural abscess, and paralysis. IMPLICATIONS: This is a case report of a disk infection (discitis) caused by the bacteria, streptococcus bovis after spinal anesthesia for cesarean delivery. S. bovis rarely causes discitis, and spinal anesthesia for labor and delivery has not been reported as a cause of discitis.
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keywords = back
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