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A toddler who refused to stand or walk: lumbar spondylodiscitis
Rick van den Heuvel1, Marc Hertel, John Gallagher
1BFG HS, Sennelager, Germany. rickvandenheuvel@doctors.org
Insights
A 19-month-old boy with reluctance to walk and fever was diagnosed with spondylodiscitis after initial normal hip ultrasounds. Prompt treatment with antibiotics led to an excellent recovery.
Area of Science:
- Pediatrics
- Orthopedics
- Infectious Diseases
Background:
- Early diagnosis of pediatric spinal infections is crucial for optimal outcomes.
- Spondylodiscitis in young children can present with non-specific symptoms, delaying diagnosis.
Observation:
- A 19-month-old boy presented with reluctance to stand/walk and mild fever.
- Initial hip ultrasound was normal; constipation and irritability developed later.
- Subsequent MRI revealed lumbar spine changes indicative of spondylodiscitis.
Findings:
- Lumbar spine MRI identified spondylodiscitis in a young child.
- The patient exhibited delayed diagnosis due to initial non-specific symptoms.
Implications:
- Highlights the importance of considering spinal pathology in young children with gait disturbances and systemic symptoms.
- Emphasizes the utility of advanced imaging like MRI when initial investigations are inconclusive.
- Early and appropriate treatment of pediatric spondylodiscitis leads to favorable prognoses.
Abstract:
A young mother presented her 19-month-old boy to the general practitioner (GP) with a 24 h history of reluctance to stand or walk and a slightly raised temperature. The GP arranged an assessment by the paediatrician, who organised an ultrasound of the hips which was normal. Approximately 1 week later the patient became constipated as well, was seen again by another GP but no cause was found. Another week later mother consulted the initial GP again as the boy had not shown any signs of improvement and had become more irritable. The GP arranged a review by the paediatrician and MRI scans of the hips and back were performed. These scans showed normal hips but lumbar spine changes suggestive of a spondylodiscitic event. The patient was treated with intravenous antibiotics, a corset and analgesia and made an excellent recovery.
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