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Painless vertebral osteomyelitis: an unusual presentation.
Mark Andrew Sohatee1, David William Shields
1NHS, Gateshead, UK.
BMJ Case Reports
|March 19, 2013
Summary
This case report highlights an unusual presentation of vertebral osteomyelitis (inflammation of the vertebral disc space) and discitis in a patient with Staphylococcus aureus bacteraemia. The infection was only identified via spinal MRI, despite the absence of typical symptoms like back pain.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Radiology
Background:
- Vertebral osteomyelitis and discitis involve inflammation of the vertebral disc space, often due to infection.
- The condition can extend to surrounding spinal structures, including the epidural space and paraspinal tissues.
Observation:
- A 68-year-old male presented with confusion and Staphylococcus aureus bacteraemia.
- Initial clinical evaluation and routine tests did not reveal a clear infection source.
- Spinal examination showed no back pain or focal neurological deficits.
Findings:
- Magnetic Resonance Imaging (MRI) of the spine was crucial for diagnosis.
- MRI revealed vertebral osteomyelitis with paravertebral abscess formation.
- This diagnosis was made despite the lack of typical spinal symptoms.
Implications:
- This case underscores the importance of considering vertebral osteomyelitis in patients with unexplained bacteraemia, even without localized spinal symptoms.
- Advanced imaging like MRI is vital for diagnosing atypical presentations of spinal infections.
- Early diagnosis and treatment are critical to prevent complications associated with vertebral osteomyelitis.
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