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Difficulties in diagnosing vertebral osteomyelitis in a child
  1. Jonathan Holzmann1,
  2. Sunday Pam2,3 and
  3. Geoffrey Clark4
  1. 1Paediatrics, Queensland Health, Brisbane, Queensland, Australia
  2. 2General Paediatrics, Rockhampton Hospital, Rockhampton, Queensland, Australia
  3. 3Rural Clinical School, University of Queensland Faculty of Medicine and Biomedical Sciences, Rockhampton, Queensland, Australia
  4. 4Central Queensland Radiology, Rockhampton Hospital, Rockhampton, Queensland, Australia
  1. Correspondence to Dr Jonathan Holzmann; jonathan.holzmann{at}health.qld.gov.au

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.

  • musculoskeletal and joint disorders
  • paediatrics (drugs and medicines)
  • bone and joint infections

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Footnotes

  • Contributors This is case report has been compiled by JH and SP who discussed and planned the case together. The data collection, literature review and reporting was completed by JH and reviewed by SP who took oversight of the project. The consent from the family was attained by SP. The imaging was re reviewed and salient images collected for the article by GC. Kind regards JH, SP and GC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.