‘He doesn’t like sitting up!’ Finding a Spinal Cause on MRI

Introduction: Discitis and vertebral osteomyelitis is an uncommon diagnosis in children and detection can be delayed because of the scarcity in incidence and lack of awareness, despite back pain being a significant cause of hospitalization in paediatrics.

Case: An 11 month old boy presented with an unusual complaint of not being able to stand with support for 3 days, with regression of other gross motor milestones. He recently had 3 weeks of lethargy and fatigue following a bronchiolitic episode but remained afebrile. He was tolerating feeds with no bowel or bladder symptoms. His developmental milestones were previously normal. His clinical examination showed bilateral lower limb hypotonia and reduced power, with decreased deep tendon reflexes and upgoing plantars. Initial bloods were normal.

His MRI spine showed marked abnormal low T1 and increased T2w signal in the L2 and L3 vertebral bodies, with loss of disc height, in addition to abnormal signal in the adjacent vertebral bodies and the surrounding soft tissues. The findings were suggestive of spondylodiscitis. He subsequently received a 4 week course of flucloxacillin, initially intravenously, then orally.

Progress: His symptoms improved over 2 months and he made an uneventful recovery in 3 months and was subsequently discharged.

Conclusion: Using MRI for spinal imaging is very useful in evaluating a child who develops a limp or in an infant who displays a postural or positional preference to rule out possible diagnosis of discitis and vertebral osteomyelitis. Such diagnosis should be considered, as spondylodiscitis generally has a good prognosis.