A 13-year-old boy was referred to the Pediatric Intensive Care Unit.
Good growth and development.
No morbid history.
Complete immunisation schedule.
He was admitted due to fever with 20 days of evolution, up to 38 °C axillary.
Forty-eight hours after the onset of fever, a permanent, progressive, non-irradiated low back pain with a nocturnal component worsened with movements.
Upon admission, the patient had limited mobility of the tocolumbar spine and walking.
She had no sphincter involvement.
She had consulted in an outpatient clinic where amoxicillin was indicated for 7 days and then cotrimoxazole for 48 hours.
Physical examination at admission showed good general condition, with myalgias, fever 38.5 °C axillary, without skin or mucosal lesions or lymphadenopathy.
The spine showed stiffness and total limitation of mobility to flexion: scoliotic attitude of the trunk, with axial deviation of 1 cm to the left.
Fixed localisation pain
Symmetric abdomen, hypogastric tenderness, no signs of peritoneal irritation or visceromegaly.
Lumbar fossae were normal.
The rest of the physical examination was normal.
Laboratory tests: leukocytes 9900/mm3 (neutrophils 4,800/mm3, lymphocytes 3,700/mm3), hemoglobin 11.1 g/dl, blood 38%, platelets 407,000/mm3.
Coagulase-negative Staphylococcus was developed in the hemocultive.
The radiography of the spine at admission showed scoliosis without structural changes, without rotational component.
Bone scintigraphy showed a mild hyperemic lesion in the early phase of the second lumbar vertebra.
Magnetic resonance imaging (MRI) showed a sutitutive process of the body of the second lumbar vertebra with involvement of the medullary canal and right foramen, with tapering of the interposed discs.
A puncture biopsy of the right vertebra was performed.
Pathology reported polymorphous proliferation with lymphocytes, polymorphonuclear cells and few eosinophils; findings compatible with osteomyelitis.
Bacteriological culture of the biopsy sample was negative.
Treatment was initiated with cefuroxime ev 100 mg/kg/day which was maintained for 23 days; vancomycin 40 mg/kg/day for 3 days, ceftriaxone 100 mg/kg/day plus rifampicin 11 days.
In total, she received 45 days of antimicrobial treatment.
An abdominal CAT scan showed hypodense images of the liver compatible with microabscesses.
In view of this finding, an argenic staining with Warthin-Starry technique was performed on the vertebral biopsy, and the presence of Gram-negative bacilli with morphology compatible with B. henselae was detected.
During evolution, he persisted with low back pain and fever for 30 days.
The patient was discharged from the hospital with facial palsy and practically normal mobility of the spine.
CRP and blood count returned to normal during follow-up.
