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A two and a half year old girl was admitted in a hospital because of belly pain, with vomiting, constipation, and poor appetite. The abdominal examination was normal. The ESR (erythrocyte sedimentation rate) was 34 mm/hour (normal 0-20). Her X-ray of the abdomen showed dilated loops of bowel. Two days later, she refused to sit up. There was tenderness at the lumbar spine area. Straight leg raising and spinal movements were limited. X-ray of the lumbar spine was normal. However, bone scan of the spine showed increased uptake at L4-5 disk space. She was diagnosed to have diskitis. The treatment given was: fusidic acid, erythromycin, and a spinal jacket for 6 weeks. She made a good recovery. Reference: Year Book of Pediatrics 1986, page 434 Comment: Diskitis is not a common cause of belly pain in children. This case is unusual, however, any child with high ESR should be suspected of having something wrong physically. Diskitis is believed to be cause by Staphylococcus bacteria infecting the space between two vertebral bodies. Some children will have no belly pain, just pain at the back or difficulty on walking. Leo Leonidas, MD, FAAP |
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