Diagnosis

What are the radiographic findings in discitis? These studies revealed a narrowing of the T3-T4 interspace. This narrowing is best seen on the AP film. It is not easily identified on the lateral film.

View a coned down view of this area in
some repeat radiographs.

These coned down views of the T3-T4 region show the narrowing on the AP and lateral views.

Based on these radiographs, he is diagnosed with suspected discitis. He is hospitalized and IV antibiotics are started. His fever eventually subsides during his stay in the hospital and he is discharged on the fourth hospitalization day. His blood culture does not grow any organisms. His PPD is negative. A repeat ESR during hospitalization is 2.

Discussion :-

This patient does not have a typical presentation for discitis, but his clinical and radiographic findings suggest this possibility. Although discitis has many clinical presentations, its typical presentation is usually a young child, most often under the age of 5, who presents with no or low-grade fever (1). The affected disk can be at the lumbar, thoracic, or cervical regions; however, the affected disk is most often found in the lumbar region of the spine which induces limping or the inability to walk. There is also point tenderness around the area of inflammation and a marked hesitation to flex the spine, which is characteristically held stiff. Although the patient in this case shows point tenderness over the thoracic spine, which led the radiographic investigation for the possibility of discitis, he did not demonstrate this characteristic splinting or hesitation in flexing the spine. In a patient with suspected discitis, a CBC, blood culture, ESR and radiographs may be helpful (1). All these investigations were done. Lab findings revealed a borderline or normal WBC at 10,800, which is common in discitis; however, his ESR, which is typically elevated in discitis, was found to be low, at 3. These two tests are non-specific for discitis and are commonly used to track the course of the disease. His blood cultures were found to be negative throughout the course of his hospitalization. This doesn't help to rule out discitis since 50%-70% of cultures, both blood and disk space, are found to be negative (1). The patient's radiographs are characteristic for discitis, demonstrating narrowing of the affected disk space. He shows disk narrowing at the T3-T4 disk, which corresponds to the point tenderness demonstrated on physical examination. There was no evidence of soft tissue abnormalities or associated bone destruction, which may help to rule out a secondary infection from a paravertebral abscess or osteomyelitis. Therefore, even though the case presentation is rather atypical of discitis, the diagnosis of discitis is possible in this case given the radiographic evidence and the clinical findings of Fosis infection, which has a higher propensity for the spine than other bones (2).