Disclosures: Maria I. Lyuksyutova, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 79-year-old male who presented with subacute low back pain and confirmed lumbar compression fracture, but incidentally found to have discitis and osteomyelitis.

Case Description or Program Description: A 79-year-old male presented to the outpatient clinic with 8 weeks of dull, aching, non-radiating, low back pain without inciting event. He had failed previous treatments of heat, ice, home exercise program, and NSAIDs. He had no history of IV drug use, recent travel, osteoporosis or spinal procedures. X-ray demonstrated mild to moderate compression deformity at L2 level. He presented to the spine clinic as a referral for kyphoplasty.

Setting: Outpatient clinic.

Assessment/Results: MRI L-spine non-contrast was obtained and demonstrated increased STIR signal at L2 with slightly increased signal intensity in the L1-2 disc. Radiology expressed findings could be attributed solely to compression fracture, but that discitis could not be fully ruled out. Patient requested to proceed with kyphoplasty, but further workup was ordered. Follow up MRI L-Spine with contrast confirmed enhancement along the L1-2 disc space and vertebral bodies. CRP and ESR were elevated and patient had slight chronic elevation in WBC. Blood cultures were negative. Infectious Disease consult was ordered, and a CT-guided lumbar biopsy was performed. Biopsy cultures were inconclusive. The patient was empirically treated with IV antibiotics for 6 weeks. His symptoms significantly improved with antibiotics.

Discussion (relevance): The incidence of spontaneous vertebral osteomyelitis and discitis is not well described in the literature. In this case, performing a kyphoplasty may have resulted in significant morbidity due to the underlying osteomyelitis. Additionally, it may have delayed appropriate diagnosis and treatment. Cost effective tests such as inflammatory markers can be useful tools in evaluating for any underlying or insidious pathology.

Conclusions: This case highlights that spontaneous osteomyelitis and discitis should be included in the differential diagnosis for lumbar compression fracture, even without the presence of obvious risk factors.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/discitis-and-osteomyelitis-masquerading-as-a-lumbar-compression-fracture-a-case-report/