3046 Unseen spine: a case of infective discitis masked by diverticulitis in elderly care patient

Abstract Introduction Spinal infections include vertebral osteomyelitis, septic discitis, facet joint septic arthritis, and spinal epidural abscesses. The common presentation usually involves back pain, fever, and elevated inflammatory markers, with signs of neurological deficits implying presence of spinal epidural abscess. Spinal infections are infrequent (0.2–3.7 per 100,000 hospital admissions for spondylodiscitis), with relatively higher incidence in elderly patients. Case presentation We present a case of an 80-year-old female patient with a complex past medical history, including chronic back pain, osteoarthritis, bladder cancer, breast cancer, and lymphedema. She presented to the emergency department with a 3-day-history of lower back pain radiating to the abdomen. There was no history of trauma. Examination revealed no signs of intra-abdominal infection. There was a significant elevation of white blood cell count and C-reactive protein (CRP). The initial CT scan identified acute, uncomplicated sigmoid colonic diverticulitis, which was treated under the surgical team conservatively with antibiotics, following which the patient was discharged. Thirteen days later, the patient represented again with the same symptoms with additional pain radiation to the right leg affecting mobility. There was lumbar spinal process tenderness on examination with persistently high inflammatory markers in blood. Blood cultures resulted positive for Streptococcus agalactiae. An MRI spine revealed infective discitis with a right paravertebral abscess, causing thecal sac compression evident on CT scan also with bilateral psoas abscess. Following starting an appropriate antibiotic course guided by the cultures, and CT-guided drainage of the abscess, the patient improved symptomatically and clinically. Conclusion Spinal infections are uncommon, yet significant aetiology of back pain. They should be considered a differential diagnosis in anyone with new or increasing back pain. The investigation and treatment approach must be guided by history taking and clinical examination.