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Difficulties in diagnosing vertebral osteomyelitis in a child
Jonathan Holzmann1, Sunday Pam2,3, Geoffrey Clark4
1Paediatrics, Queensland Health, Brisbane, Queensland, Australia jonathan.holzmann@health.qld.gov.au.
Insights
Pediatric vertebral osteomyelitis diagnosis can be delayed. This case highlights how bone scans and further MRI confirmed infection despite initial negative imaging, emphasizing clinical suspicion.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal imaging
- Diagnostic challenges in pediatrics
Background:
- Vertebral osteomyelitis is uncommon in children, often leading to delayed diagnosis.
- Early recognition is crucial for effective treatment and preventing complications.
Observation:
- A child presented with fever, back pain, and elevated C-reactive protein, indicating Staphylococcus aureus bacteremia.
- Initial CT, MRI, and ultrasound scans did not reveal vertebral osteomyelitis or the source of bacteremia.
Findings:
- A bone scan detected increased metabolic activity in the 12th thoracic vertebra (T12).
- A subsequent focused MRI of T12 confirmed the diagnosis of vertebral osteomyelitis.
Implications:
- This case underscores the diagnostic difficulties in pediatric vertebral osteomyelitis.
- Clinicians must maintain clinical suspicion and utilize further investigations when initial imaging is inconclusive to ensure timely diagnosis.
Abstract:
Vertebral osteomyelitis is a rare diagnosis and often delayed diagnosis in children. This is a case of a child presenting with fever, back pain and raised C reactive protein who was found to have a Staphylococcus aureus (S.aureus) bacteraemia. Initial imaging with CT, MRI of the spine and abdominal ultrasound failed to demonstrate a vertebral osteomyelitis or identify another source of the bacteraemia. Due to the high clinical suspicion of a spinal source of the infection, second-line investigations were arranged. A bone scan identified an area of increase metabolic activity in the 12th thoracic vertebrae (T12) and subsequently a diagnosis was confirmed with a focused MRI of T12. This serves as an opportunity to discuss the diagnostic difficulty presented by paediatric vertebral osteomyelitis and more generally the need for clinicians to pursue their clinical suspicion in the face of false negative results to make an accurate and timely diagnosis.
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