A 9 month old, previously healthy boy presented with low grade pyrexia, refusal to sit or stand, and increased irritability. His systemic and neurological examinations were normal. Local examination did not reveal any swelling or tenderness over his spine. His white cell count was normal; C reactive protein and ESR were raised. His blood culture was sterile. Ultrasound scan of the hips was normal. Spine x ray examination showed a narrow disc space at L2–L3 (fig 1). Magnetic resonance imaging confirmed the diagnosis of lumbar discitis (fig 2). He responded well to oral antibiotics.
Figure 1 Spine x ray showing narrowing of disc space at L2–L3.
Figure 2 MRI of spine showing narrowed disc space at L2–L3 with increased signal density. There is slight signal change in anterior epidural space due to granulation tissue.
Lumbar discitis is uncommon in children. Few cases have been reported in the literature.1,2
It has a biphasic age distribution, with higher incidence early in childhood and a subtler peak during adolescence. Clinical manifestations vary with age. Infants may present with irritability, toddlers may refuse to walk, while adolescents typically complain of back pain. The presence of fever is variable. Blood inflammatory markers are raised. The aetiology appears to be a bacterial infection usually caused by Staphylococcus aureus but blood cultures are often sterile. Radiographic evidence lags behind clinical signs and symptoms and x ray examination of the spine may be normal if done shortly after the onset of illness, or it may show narrowing of disc space. Magnetic resonance imaging of the spine is diagnostic. It shows irregularity and destruction of the vertebral end plates and body, increased signal intensity on T2 weighted images, and bone destruction within adjacent vertebrae. Treatment with immobilisation and appropriate antibiotics is indicated. Discitis is usually a benign and self‐limiting disease in children.3 Even though it is uncommon in children, the index of suspicion should be high in a child presenting with fever and refusal to sit or walk.
Footnotes
Competing interests: none declared
References
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