Secondary Discitis Masquerading as Treatment Failure of Primary Discitis: Case Report and Review of the Literature.

BACKGROUND: Vertebral osteomyelitis often presents with localized back pain at the site of infection and elevated inflammatory markers. It can generally be treated conservatively with antibiotics targeted at the causative microorganism, but failure of medical treatment often necessitates surgical debridement. There are no reports in the literature that describe a secondary infection masquerading as treatment failure of the primary infection.

METHODS: We present a case of a 29-year-old male with a history of intravenous drug abuse who was treated with antibiotics for methicillin-sensitive Staphylococcus aureus T6-7 discitis/osteomyelitis. The patient later returned with worsened back pain and was initially thought to have experienced failure of medical therapy, but instead was found to have a secondary discitis at a different level, with biopsy-proven different microorganism (Enterobacter cloacae).

CONCLUSIONS: This case illustrates the possibility of secondary discitis masquerading as treatment failure of the primary discitis. Repeat imaging and biopsy of the new lesion avoided a surgical procedure in this patient.