Purpose or Case Report: To present two rare cases of spondylodiscitis of the infant age group who refused to walk and stand. Both had no fever and showed only mild laboratory signs of infection with slight CRP and ESR elevation without leukocytosis.
Methods & Materials: The clinical, laboratory and imaging data of two infants (girl and boy, 30 and 18 months of age, respectively) with spondylodiscitis are presented. Both underwent sonography of the hips and the knee joints, radiographs of the hip and leg as well as MRI scan of the lumbar spine and the pelvis.
Results: Initial CRP and ESR were 36/21 mg/l and 44/70 mm respectively after the first hour. Both had no fever and no leukocytosis. All blood cultures during the course were negative.
Sonography ruled out effusion of the hip and knee joint. Radiographs of the hip and the knee were unremarkable with no evidence of a toddler fracture. The MRI scan of the lumbar spine showed signs of spondylodiscitis at the level of L4/S1 with reduction of the disc height, increased contrast enhancement of the adjacent vertebra as well as a small prevertebral soft tissue abscess in both cases.
Onset of symptoms to final diagnosis took 5 and 6 weeks, respectively. Both were treated with intravenous antibiotics for 3 weeks without complications. No needle biopsy for pathogen isolation was performed.
Conclusions: Spondylodiscitis in infants is uncommon to rare and can present with subtle and unspecific signs and symptoms. It can mimic typical diseases of that age like coxitis fugax or a toddler fracture.
These unspecific clinical findings can lead to delayed diagnosis. In the literature a delay in up to 3 months is described in 50% of the cases.
An awareness of this rare diagnosis in this age group can shorten the diagnostic process especially if laboratory findings show signs of an infection.