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[Lumbar spondylodiscitis caused by Salmonella enteritidis]
A Schüler1, D Schaumann, M P Manns
1Abteilung Gastroenterologie und Hepatologie, Zentrum Innere Medizin der Medizinischen Hochschule Hannover.
Abstract:
A 19-year-old boy developed paravertebral muscular pain in the lumbar region after an episode of extremely arduous sporting activity, with fever followed by meningism. The cerebrospinal fluid showed a reactive pleocytosis. Initially, no acute inflammatory changes were present on serum and blood analysis, although the erythrocyte sedimentation rate was moderately increased to 25/60 mm. Pyrexia of up to 38.5 degrees C developed 6 days after admission. Because Borrelia IgM and IgG titres were positive, the diagnosis was at first thought to be atypical borreliosis and the patient was treated with antibiotics. However, after a further episode of fever. Salmonella antibody titres, which had initially been normal, rose to 1: 3200 (Salmonella typhi O and H antigens) and 1: 12800 (Salmonella enteritidis, H antigen). At this stage, the erythrocyte sedimentation rate rose to 86/120 mm and the C-reactive protein to 77 mg/dl. The white cell count remained normal throughout. Blood cultures grew Salmonella enteritidis. Abnormalities on bone scintigraphy were confirmed by CT and MRI scans, showing spondylodiscitis of lumbar vertebrae 1 and 2 with limited osteolysis. The lesion resolved completely on 6 week's treatment with ciprofloxacin (200 mg twice a day intravenously) and conservative supportive treatment. Spondylodiscitis is an uncommon complication of salmonellosis and may occur long after the diarrhoea. Cross reactions with Borrelia flagellin antigens may lead to the wrong diagnosis being made.
Insights
A rare case of Salmonella spondylodiscitis in a young male, initially misdiagnosed as borreliosis due to cross-reacting antibodies, highlights the importance of comprehensive diagnostics for infectious spondylitis.
Area of Science:
- Infectious Diseases
- Orthopedics
- Microbiology
Background:
- Salmonellosis is a common bacterial infection, typically causing gastrointestinal symptoms.
- Spondylodiscitis, an infection of the spine and intervertebral discs, is an uncommon but serious complication of salmonellosis.
- Accurate diagnosis can be challenging due to atypical presentations and potential for cross-reactivity in serological tests.
Observation:
- A 19-year-old male presented with lumbar pain, fever, and meningism after strenuous exercise.
- Initial investigations revealed reactive pleocytosis and moderately elevated erythrocyte sedimentation rate, with positive Borrelia antibodies leading to a suspected diagnosis of borreliosis.
- Subsequent fever spikes and rising Salmonella antibody titers, alongside positive blood cultures for Salmonella enteritidis, indicated salmonellosis as the causative agent.
Findings:
- Imaging studies (CT and MRI) confirmed spondylodiscitis of lumbar vertebrae 1 and 2 with osteolysis.
- The patient's white blood cell count remained normal throughout the illness.
- Treatment with ciprofloxacin and supportive care led to complete resolution of the spinal lesion.
Implications:
- This case underscores the potential for Salmonella to cause spondylodiscitis long after initial gastrointestinal symptoms.
- Serological cross-reactivity between Borrelia and Salmonella antigens can lead to diagnostic delays and misdiagnosis.
- Comprehensive diagnostic workup, including blood cultures and advanced imaging, is crucial for identifying uncommon complications of salmonellosis.