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Central Chest Pain - An Atypical First Presentation.

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Summary

Thoracic spondylodiscitis, a rare spinal infection, can present as central chest pain. Early suspicion is key for timely diagnosis and treatment, especially with rising inflammatory markers and back pain.

Keywords:
Central chest painT6-7 nerve root compressionthoracic spondylodiscitis

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Area of Science:

  • Medical Diagnostics
  • Infectious Diseases
  • Spinal Imaging

Background:

  • Thoracic spondylodiscitis is a rare spinal infection.
  • Diagnosis is challenging, particularly with atypical symptoms like central chest pain.
  • Prompt identification is crucial for effective treatment and patient outcomes.

Observation:

  • A 54-year-old male presented with central chest pain and elevated C-reactive protein (CRP).
  • Symptoms progressed over six weeks to include back pain, sepsis, and neurological deficits.
  • Magnetic resonance imaging (MRI) revealed T6-T7 disc space destruction.

Findings:

  • Blood cultures confirmed Staphylococcus aureus infection.
  • The patient received 15 weeks of combined intravenous and oral antibiotics.
  • Complete symptom resolution was achieved post-treatment.

Implications:

  • Highlights the importance of considering spondylodiscitis in patients with central chest pain, unresolving back pain, and elevated inflammatory markers.
  • Emphasizes the need for a high index of suspicion in diagnosing this rare condition.
  • Underscores the effectiveness of prompt antibiotic therapy in managing thoracic spondylodiscitis.