Female patient, aged 2 years and 7 months, mestizo, from the rural area of the city of Palmira, Department of Valle del Cauca in Colombia.
She presented with a 3-month history of refusal to walk, pain with standing and sitting, mainly in the left lower limb, and later presented difficulty standing.
Afebrile during all its evolution, with intermittent pain manifestations which partially decreased with the administration of acetaminophen, 15 mg/kg/dose.
No personal history of trauma, connective tissue disease, hypertension, diabetes, congenital heart disease or tuberculosis was found.
Perinatal history was unknown because the patient was delivered for adoption and was protected from a mother who was born in the supine position.
The initial physical examination showed good general condition, normal weight, hemodynamically stable.
Rejection of the standing and gait stand out, with irritation to the flexion of the hips, pain reduction and lordosis of the lumbar region, contracture of the muscles for lumbar spine, low back pain.
No Gowers maneuver or neurological involvement was found.
Blood count, C-reactive protein (CRP) of 7 mg/dl (range 0 to 5 mg/dl), Salmonella Sedimentation Rate, Globular Antigen test (SGV) of 40 mm normal function, urine tests
Among the imaging studies highlighted chest radiography, lumbar region and hips reported as normal.
Magnetic resonance imaging (MRI) with pelvic contrast with emphasis on the left hip showed coxofemoral joint involvement, with normal femoral head nuclei, acetabulum appropriate at the coronal and sagittal planes.
Alteration of the L5-S1 disc was found, with bone erosions compatible with spondylodyscitis.
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An intentional search for tuberculosis was performed and Pott's disease was ruled out as a differential diagnosis; with Tuberculin Test (PPD), three serial bacilloscopy (BK) in chest, three serial CT scans.
During the clinical evolution, an exacerbation of pain manifested in rejection of standing and gait was documented, with irritability to hip flexion.
During follow-up with acute phase reactants, elevated CRP to 12 mg/dl and ESR to 60 mm/h were observed.
Surgical exploration and drainage of 2 cc of purulent material secretion, culture and biopsy were performed.
The biopsy reported: usual bone trabeculae and bone marrow with medullary space with cellularity of 30%, preservation of the granulo-erythroid relationship, without evidence of granulomatous inflammation or neoplasic process.
Negative report for cultures (including studies for Brucella and Bartonella), neoplasia and tuberculosis.
In an interdisciplinary medical board, antibiotic treatment was decided with intravenous Clindamycin 40 mg/kg/day and Ceftriaxone 100 mg/kg/day for 4 weeks and 2 weeks with oral Cephalexin.
For pain management, the patient received NS and physical rehabilitation was indicated until complete resolution of the clinical picture, evidenced in the absence of pain, improvement in standing, gait and normalization of acute phase reactants.
