62 Rachialgia of difficult diagnosis: an unusual clinical form!

Abstract

Abstract Background Spinal pain is a frequent symptom whose aetiology can be extremely varied. It is not only the prerogative of adults; it is frequent in children and particularly in adolescents. Inflammatory spinal pain is a warning sign that should prompt further investigations to rule out an underlying pathology such as infectious spondylodiscitis, malignant pathology, ankylosing spondylitis or SAPHO syndrome. In this case, we report on a 15-year-old child with uncommon inflammatory spinal pain that caused diagnostic difficulties. Observation The child B.A., aged 15 years, with no previous history, consulted for inflammatory back pain that had been evolving for >3 months in a context of apyrexia and conservation of the general state, associated with pain of the anterior thoracic wall. The clinical examination revealed an exaggerated dorsal kyphosis, a lumbar spinal syndrome. The rest of the joint examination was without abnormalities and the somatic examination revealed a retention acne. Biologically, there was no inflammatory syndrom, brucella serology and tubeculin TST were negative. An X-ray and a CT scan of the dorsal-lumbar spine showed multiple bone erosions of the vertebral plates and a fracture of the T6 and T7 vertebrae with global disc pinching, without recession of the posterior wall or damage to the soft tissues and with exaggeration of the dorsal cyphosis at this level. The spinal MRI revealed a spondylodiscitis with hypo T1 hyper T2 signal at the T6-T7 level without any collection. An osteolytic lesion of the sternal manubrium lateralized to the left with blurred contours was objectified by the CT scan of the anterior chest wall. Bone scans revealed intense hyper fixation foci at the T6-T7 level and the sternal manubrium. MRI of the sacroiliac joints was normal. A scan-guided biopsy of the T6-T7 level did not show any specific lesion. In view of the inflammatory spinal pain, the anterior chest wall pain, the negativity of the biological tests and the imaging data, the diagnosis of incomplete SAPHO syndrome was retained after having ruled out other etiologies. SAPHO syndrome is a rare entity that refers to the association of a heterogeneous set of cutaneous and osteoarticular manifestations with a common denominator of an aseptic inflammatory process. It remains a diagnosis of elimination. Conclusion Spinal pain in children can be a symptom of multiple etiologies and sometimes poses a diagnostic problem. This is a particular observation and deserves to be reported because unusual clinical forms of SAPHO syndrome exist and should not be ignored.