A 10-year-old previously healthy girl presented to the pediatric emergency department complaining of low back pain for four days, after intense physical activity.
Later impotence was added to walk.
She had no recent history of travel abroad, direct trauma, or wounds.
A fever of 39 °C, hypogastric and lumbar pain, associated with difficulty walking and general malaise, was added 48 hours after the onset of pain.
He had no vomiting, diarrhea or dysuria.
She was hospitalized with suspected septic spondylitis.
Physical examination revealed an axillary temperature of 38.8°C, marked pain at palpation of the right lumbar area, with no inflammatory signs on the skin of this area or regional lymph nodes.
Highlight laboratory tests: blood count with white blood cell count of 9,400/mm3 (neutrophils 78%, bacilliforms 2%), hemoglobin 14.9 g/dL, ESR 16 mm/h and complete CRP 6.
Abdominal ultrasound showed mildly enlarged mesenteric lymph nodes, with nonspecific appearance.
Empirical treatment with cloxacillin and cefoxime iv was started after obtaining hemocultive (2) and urocultive.
Magnetic resonance imaging of the lumbosacral spine showed extensive edema of the muscles paralysis with a small right lateral predominance, extending from L1 to the sacral region, more located between L4 and S1 to the left, and the presence of L4 inter5 collection.
Concomitant ultrasound of blade tissues showed the presence of a poorly defined hypoechogenic, polylobulated 1.5 x 0.9 cm collection, with significant edema of the adjacent fat.
A blood culture was positive for S. aureus sensitive to cloxacillin, suspending cefoxime.
Secondary foci were completed with echocardiography, chest X-ray and bone scintigraphy, which were normal.
Urocultiva was negative and creatine kinase was 88 U/L (normal value 25-177 U/L).
On the third day of hospitalization, the fever curve decreased, CRP decreased to 7.8 mg/dL and then to outpatient antibiotic therapy (day 5) and 1.3 mg/dL (day 7) due to cefoxide, a good date.
A dorsolumbar control ultrasound examination revealed no evidence of seizures.
