The patient was 3 years old 2 months old, male, with a history of neonatal asphyxia secondary to circular neck, bronchopneumonia due to a complete respiratory virus without immunization at 6 months of age, and a vaccination schedule for the national program.
The clinical picture began two months before the diagnosis, with gastrointestinal symptoms constipation, diffuse, intermittent abdominal pain, which intensified in the following two weeks.
She repeatedly attended pediatrician and pediatric gastroenterologist, indicating diet and lactulose; abdominal ultrasound was also performed, which was normal.
Three weeks later, the patient suffered from weakness, nocturnal irritation, low back pain and later relative prostration (non-smoking, non-smoking) and difficulty sitting.
A lumbar spine x-ray with normal results was requested.
Due to the persistence of symptoms, she was hospitalized with the hypothesis of Guillain syndrome.
A second lumbar spine X-ray and neurological evaluation were normal.
Hematocrit was 37.7%, white blood cell count was 9,300/mm3, without left shift, platelet count within normal range and ESR was 48 mm/hour, with CRP of 6.5 mg/dL (normal: 0-1).
A bone scintigraphy showed increased uptake at L2-L3.
As a result of this finding, the anterior column x-ray was re-evaluated, showing a decrease in the interlacency space L2-L3.
Magnetic resonance imaging (MRI) of the spine was compatible with spondylodyscitis.
The puncture of the vertebral disc at L2-L3 level under computerized axial tomography (CT) showed fluid with abundant polymorphonuclear.
The patient was sent to current culture, Koch culture and polymerase chain reaction (PCR) was requested to study universal 16S RNA.
Blood cultures were negative and empirical antimicrobial treatment with cloxacillin and cefoxime IV was started, as well as analgesia with ketoprofen.
The patient was admitted favorably with fever and decreased pain.
Control tests showed slow regression of inflammatory infectious parameters, with 8,900 leukocytes/mm3 without left shift, ESR of 35 mm/hour and CRP of 4.4 mg/dL.
Culture of the articular fluid was negative and the universal PCR showed the presence of K. kingae.
After completing the 10 days of treatment iv, and given the good clinical and laboratory evolution, it was decided to discharge the patient, with immobilization through a corset and with indication to complete four weeks orally with amoxicillin.
