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This 15 year old boy with back pain has Diskitis. It is an infection of an intervertebral disk usually associated with Staphylococcus aureus bacteria. Infection with Mycobacterium tuberculosis is less likely.

The imaging that bagged the diagnosis is MRI of the spines which showed abnormality at the T7 and T8 (thoracic vertebral number 7 & 8).

The boy was given intravenous Nafcillin. Four weeks later his back pain was reduced and his blood count called ESR (Erythrocyte Sedimentation Rate) was back to normal. Long term antibiotic is the main treatment.

The differential diagnosis considered in this case are: osteomyelitis, soft tissue abscess, lung abscess, tumor of the spines, and leukemia.

The long term outcome of Diskitis is generally good. However some patients might have kyphosis (abnormal curvature of the spines).

Diskitis is not a common illness in children. It is difficult to diagnose without CT or MRI. Sometimes bone scan and x-ray of the spines might help in the diagnosis.

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Leo Leonidas, MD, FAAP

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