Discitis

Exam Cram

• Discitis is an infection of the intervertebral discs

• Presentation: vague back pain, low grade fevers, anorexia, & spinal tenderness, raised CRP +++

• Diagnosis: MRI (CT can shows subtle changes)

• Management: IV antibiotics 6 weeks

Deeper Dive

• Easy diagnosis to miss and argument for doing a CRP

• CT: shows loss of vertebral disc height (often worth calling radiology to specifically comment)

Post MRI Diagnosis Work Up

1. Identify organism

   • Blood cultures daily for three days

   • Bone biopsy under interventional radiology

   • ECHO ? Infective Endocarditis 

2. Monitor

   • Antibiotics not required unless septic or immunocompromised until organism is identified

   • Usual course flucloxacillin IV + PO 6 weeks

   • Ceftriaxone alternative if penicillin allergy

3. Disposition

   • Usually managed by infectious diseases (or general medicine)

   • May require prolonged IV antibiotics and be a candidate for Hospital @ Home with a PICC line

References and Resources

Written 2024.