Vertebral osteomyelitis in a high school hockey player: a case report

To present the case of a high school hockey player with vertebral osteomyelitis in the body of the third lumbar vertebra.

Vertebral osteomyelitis is an infrequently reported cause of back pain in otherwise healthy adolescent athletes. Osteomyelitis is an inflammation of bone caused by a pyogenic organism. It can remain localized or spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum.

Lumbar dysfunction, tumor, fracture, and degenerative conditions.

High-dose intravenous antimicrobial therapy for 4 to 6 weeks is the rule; rest, limitation of movement, and analgesics as needed; and periodic reevaluation for complications.

An otherwise healthy student-athlete developed low back pain with no history of acute trauma or significant medical history. Back pain and fever began approximately 4 weeks before the athlete reported to the athletic trainer. At the onset of symptoms, the patient took acetaminophen, which reduced the fever. Back pain remained, however, and increased to a radiating left-sided pain. At this point, the patient saw a pediatrician, who treated him for influenza-like symptoms with oral antibiotics. Symptoms decreased, probably from a dampening of the infection as a result of the antibiotics, but back pain was not completely resolved. A magnetic resonance imaging scan was ordered by a consulting orthopaedic surgeon for suspicion of hereditary disc disease or infection. It was at this time that the patient presented his complaints to the school athletic trainer. The physical assessment was indicative of typical low back pain of a mechanical nature. Development of high fever and chills prompted the athlete's visit to the family physician, who reviewed the magnetic resonance imaging report of abnormal L3 vertebral body uptake and ordered standard blood work. His initial impression was a bone contusion and influenza-like symptoms. However, laboratory results 48 hours later suggested probable infection, and the athlete was referred to a pediatric orthopaedic specialist. A diagnosis of osteomyelitis was made, and the patient was admitted emergently for open biopsy, irrigation, and débridement. After appropriate treatment, he returned after 5 months to full activity with no complications.

Low back pain can have many etiologies. Health care providers need to be aware of the distinctive features of vertebral osteomyelitis, so that they can recognize the disorder and institute appropriate diagnostic testing and treatment. Early diagnosis and identification of the infecting microbe are the keys to determining the appropriate antimicrobial therapy and reducing complications and the need for surgical intervention.