Description
A previously healthy girl aged 15 years presented with a 3-month history of low back pain, lethargy, morning stiffness and nocturnal back discomfort. She had no significant history of weight loss, infective symptoms or neurological symptoms, including bladder or bowel incontinence. There was no recent travel history.
Examination revealed normal temperature and mild focal tenderness over the midline lumbar spine, with normal range of motion. There was isolated weakness in left hip flexion, and no other neurological findings. Blood tests showed a normal white cell count (6.6x109/L), elevated erythrocyte sedimentation rate (38 mm/hour) and slightly elevated C reactive protein (11 mg/L, normal<10 mg/L). X-rays were unremarkable. A limited CT of L3 showed diffuse sclerosis of its spinous process with areas of lytic destruction and mild effacement of the paravertebral fat pads (figure 1). Serial blood cultures were negative for microorganisms. Subsequent empirical antibiotics with intravenous flucloxacillin were initiated...
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