Septic Discitis: A Important Cause of Back Pain

A 65-year-old man with a 3-month history of intractable back pain had previously received cytotoxic curative chemotherapy for non-Hodgkin's lymphoma. His postchemotherapy course had been complicated by febrile neutropenia, recurrent coagulase-negative staphylococcal bacteremia, and gastrostomy site infections. He was admitted with severe intractable lower back pain requiring high doses of intravenous narcotic analgesia. Magnetic resonance imaging of the spine was highly suggestive of disk infection. Fluoroscopically guided needle aspiration of the disk space was confirmatory, and both tissue and blood cultures were positive for coagulase-negative Staphylococcus species. Treatment included IV vancomycin and oral levofloxacin. The most common organism causing disk space infection is Staphylococcus aureus, but Staphylococcus epidermis should be considered in immuno-compromised patients. Septic discitis is an important differential diagnosis of back pain and should be considered in any clinical situation associated with bacteremia.