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• W2066703487 abstract "To the Editors: A healthy 15-year-old male presented with a 6-month history of thoracic pain most prominent in the lower ribcage near the right midaxillary line. The patient associated the onset of pain with a muscle strain sustained while weightlifting 6 months earlier. The pain was cramping, intermittent, nonradiating, and worse in the mornings, during exercise, and when flexing to the right side. He denied fever, weight loss, night sweats, respiratory, or gastrointestinal symptoms, and had no neurologic symptoms. His personal and family medical histories were unremarkable. The physical examination was normal except for tenderness to palpation halfway between the vertebral column and the right midaxillary line at the T9 to T10 levels, without localized swelling, erythema, or fluctuance. There was no tenderness and there were no step-offs of his spinous processes. He rotated his trunk hesitantly and slowly and reported 5/10 pain when flexing or extending his back and when bending to either side. The complete blood count and comprehensive metabolic panel were normal with the exception of an alkaline phosphatase of 305 IU/L (normal 70-260 IU/L). The erythrocyte sedimentation rate was 29 mm/h (normal 0–20 mm/h) and the C-reactive protein was 1.9 mg/L (normal 0–10 mg/L). Magnetic resonance imaging revealed T9–T10 discitis and osteomyelitis with a mild compression fracture of the superior endplate of T10. Also seen was a paraspinal phlegmon without epidural abscess or intrathecal extension. Biopsies of the T9–T10 intervertebral disc and the T9 and T10 endplates were performed under fluoroscopic guidance. Pathologic examination of these specimens was consistent with discitis-osteomyelitis. Routine aerobic cultures of disc and bone both yielded Streptococcusagalactiae (also known as Group B Streptococcus or GBS). Anaerobic, fungal, and AFB cultures were negative, as was PCR for Bartonella. A tuberculin skin test and serum Bartonella antibodies were negative. Because GBS was unexpected from this site in a patient this age, a screen of the patient's immune status was undertaken. The HIV antibody was negative; serum immunoglobulins, total hemolytic complement, and neutrophil oxidative burst were normal; serum antibody values were consistent with an appropriate response to routine immunizations. The patient was placed in a thoracolumbosacral orthosis and he was treated with 8 weeks of intravenous antibiotics. The rate of GBS infection in neonates has decreased since the institution of universal screening of pregnant women.1 Invasive GBS disease remains a significant cause of morbidity and mortality in nonpregnant adults, almost exclusively in those with underlying immunocompromising conditions.1,2 Although uncommon, discitis and vertebral osteomyelitis caused by GBS have been described, primary in elderly or immunocompromised patients.3–5 Our search of the literature did not reveal any cases of GBS discitis or vertebral osteomyelitis in children outside of the neonatal period. The isolation of GBS in our healthy adolescent patient from both the vertebral body and intervertebral disc makes his unusual presentation of discitis even more remarkable. Clinicians should be aware of the possibility of GBS as a pathogen in discitis and vertebral osteomyelitis, especially, although not exclusively, in immunocompromised patients. Indi Trehan, MD, MPH, DTM&H Stephanie A. Fritz, MD, MSCI Department of Pediatrics Washington University St. Louis, MO" @default.
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• W2066703487 date "2009-06-01" @default.
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• W2066703487 title "Group B Streptococcus Vertebral Osteomyelitis-Discitis in an Immunocompetent Adolescent" @default.
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• W2066703487 doi "https://doi.org/10.1097/inf.0b013e3181a4ce6e" @default.
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