Spondylodiscitis associated with multiple level involvement and negative microbiological tests: an unusual case

Area of Science:

• Infectious Diseases
• Radiology
• Orthopedic Surgery

Background:

• Spondylodiscitis, an infection affecting the spine, poses diagnostic and treatment challenges.
• Delayed diagnosis and inadequate treatment can lead to severe complications.

Observation:

• A previously healthy 52-year-old male presented with severe, acute back pain, initially misdiagnosed as myofascial pain.
• Elevated inflammatory markers (ESR, CRP) were noted, but leukocyte count was normal.
• MRI revealed multilevel spondylodiscitis (T12-L4) with paravertebral involvement, despite negative initial cultures and biopsy.

Findings:

• The patient received oral amoxicillin and clavulanate, showing a positive clinical response.
• Follow-up imaging over six months demonstrated reduced inflammation and no vertebral destruction.

Implications:

• Spondylodiscitis can present atypically, even in healthy individuals, emphasizing the need for broad differential diagnoses.
• Prompt recognition and appropriate antibiotic therapy are vital for favorable outcomes in spinal infections.