PP09.15 – 2892: Exaggerated lordosis as presenting feature of discitis

Abstract

Objective To describe the atypical presentation of lumbar discitis with exaggerated lordosis. Methods Case presentation of a 23 month old previously well child presented with 2 weeks history of refusal to walk. There was no preceding history of trauma or fever. During the first week of illness she was seen by health professions on three separate occasions and underwent investigations in the form of blood infection markers and ultrasound of her hips all which were normal except for raised ESR (35). Provisional diagnosis of irritable hip was made and the parents were informed to return back if still not better in a week time. On her presentation mum mentioned that the child appears in constant pain and has recently started refusing to lie on her back, preferring lie on her side or on her tummy. On her assessment, she was apyrexial, alert and with normal neurological examination including lower limb tone, reflexes and down-going plantars on both sides. There was full range of movements along her hip joints with no discomfort. With one hand held she could walk for short distance demonstrating significantly exaggerated lumbar lordosis. There was associated tenderness along the lower lumbar spine and spasms of para-spinal muscles. Results X-ray spine and MRI spine with contrast clinched the diagnosis of discitis involving lumbar disc 2–3 region. She made complete recovery with 2 weeks of intravenous followed by 4 weeks of oral antibiotics. Conclusion We recommend that discitis should be considered in any child presenting with refusal to walk and abnormal posturing and early use of MRI spine to establish the diagnosis. Prognosis is excellent with complete clinical recovery if diagnosed and managed early. Delay in diagnosis may lead to neurological complications secondary to spinal nerves and/or cord compression.