Recurrent discitis in the acute rehab setting: a case report

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Rehabilitation Medicine

Background:

• Discitis, an intervertebral disc infection, poses risks of paralysis, sepsis, and epidural abscess.
• Diagnosis can be obscured by minimal laboratory abnormalities.
• Recurrence is a significant concern in patients with prior discitis history.

Purpose of the Study:

• To highlight the clinical presentation of recurrent discitis.
• To emphasize the importance of a low threshold for diagnosis in at-risk patients.
• To underscore the need for prompt investigation of unexplained back pain.

Main Methods:

• Case report of a 67-year-old female in an acute rehabilitation setting.
• Evaluation of sudden, unexplained back pain refractory to analgesia.
• Monitoring of inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) and comparison with baseline.
• Utilizing blood cultures and imaging for diagnostic confirmation.

Main Results:

• The patient presented with sudden, severe back pain.
• Initial vital signs and basic laboratory tests were unremarkable.
• Elevated inflammatory markers (CRP and ESR) indicated active infection.
• Recurrent discitis was confirmed through blood cultures and imaging.

Conclusions:

• Recurrent discitis requires a high index of suspicion, especially in patients with a history of the infection.
• Sudden, unexplained back pain in these patients warrants prompt diagnostic workup, including inflammatory markers and imaging.
• Early detection and treatment are vital to prevent severe complications associated with discitis.