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Janahi SM, Ashoor WA, Alshaikh AA, Seroor RH. Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943010. [PMID: 38669213 PMCID: PMC11060496 DOI: 10.12659/ajcr.943010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/16/2024] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Infantile spondylodiscitis is a rare condition with a varied clinical presentation. Microbial infection may not always be identified, but early diagnosis and management are required to prevent long-term and irreversible complications, including spinal deformities and vertebral instability. CASE REPORT This report is of a 21-month-old girl with a 3-week history of difficulty in walking and constipation due to L1-L2 spondylodiscitis following a gluteal skin burn. The family had sought medical advice multiple times, but results of all investigations were unremarkable. Her initial spine X-ray was negative but her spine magnetic resonance imaging (MRI) showed a picture suggestive of spondylodiscitis, which then responded to empiric treatment with broad-spectrum antibiotics. The patient showed complete resolution of clinical symptoms and her bowel habits came back to normal after 6 months of complete antibiotics treatment. Her repeat spine MRI showed a significant improvement of her spondylodiscitis. CONCLUSIONS This report has highlighted the importance of rapid diagnosis and management of infantile spondylodiscitis and the challenging approach to treatment when no infectious organism can be identified, as well as the early initiation of antibiotics therapy when appropriate in pediatric patients to avoid serious neurological complications associated with spondylodiscitis. Thus, it is essential to assess children with refusal to walk, gait problems, or back discomfort, especially when they are associated with high inflammatory markers.
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Affiliation(s)
| | | | | | - Raafat Hammad Seroor
- Department of Pediatric Neurology, Bahrain Defense Force Hospital, Riffa, Bahrain
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Yagdiran A, Meyer-Schwickerath C, Wolpers R, Otto-Lambertz C, Mehler K, Oberthür A, Kernich N, Eysel P, Jung N, Zarghooni K. What Do We Know about Spondylodiscitis in Children? A Retrospective Study. CHILDREN 2022; 9:children9081103. [PMID: 35892606 PMCID: PMC9331686 DOI: 10.3390/children9081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022]
Abstract
Pediatric spondylodiscitis (PSD) is a rare disease with a major impact on mobility and functional status. Data concerning demographic and microbiological characteristics, clinical course, treatment, and outcome are scarce. Therefore, the aim of this study was to present clinical experiences of a third-level hospital (2009–2019) in PSD and compare these with adult spondylodiscitis (ASD). Of a total of 10 PSD patients, most of the infants presented with unspecific pain such as hip pain or a limping, misleading an adequate diagnosis of spine origin. Eight patients could be treated conservatively whereas surgery was performed in two cases with one case of tuberculous PSD (tPSD). The causative agent was detected in three of the patients. The diagnosis of PSD is often difficult since clinical symptoms are unspecific and causative pathogens often remain undetected. Nevertheless, empirical anti-infective therapy also seems to be effective. Based on recent studies, clinicians should be encouraged to keep the duration of anti-infective therapy in children short. Since comorbidities are not presented in PSD it is unclear which children suffer from PSD; thus, studies are necessary to identify predisposing factors for PSD. In our study, PSD differs from ASD in diagnostic and especially in therapeutic aspects. Therefore, specific guidelines for PSD would be desirable.
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Affiliation(s)
- Ayla Yagdiran
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
- Correspondence:
| | - Charlotte Meyer-Schwickerath
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology, University of Cologne, 50937 Cologne, Germany; (C.M.-S.); (N.J.)
| | - Raphael Wolpers
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Christina Otto-Lambertz
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Katrin Mehler
- Department of Pediatrics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (K.M.); (A.O.)
| | - Andre Oberthür
- Department of Pediatrics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (K.M.); (A.O.)
| | - Nikolaus Kernich
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Peer Eysel
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology, University of Cologne, 50937 Cologne, Germany; (C.M.-S.); (N.J.)
| | - Kourosh Zarghooni
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
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