title: [Spondylodiscitis without fever: a diagnostic challenge].
abstract: METHODS
  Three patients with different forms of vertebral osteomyelitis are presented, two with hematogenous infections caused by Streptococcus pneumoniae and Staphylococcus aureus and one with postsurgical infection after excision of a vertebral disc caused by coagulase-negative staphylococci. None of the patients was initially febrile, but all had localized back pain and a restricted range of movement of the vertebral column. EXAMINATIONS, DIAGNOSIS: In all three patients the MRI of the affected vertebral column was consistent with vertebral osteomyelitis. Microbiological diagnosis was made by bone biopsy in all patients and by blood cultures in two of them.
  
  
  METHODS
  Antibiotics were administered for 4-6 weeks. At follow-up two patients were without symptoms, but the third patient had persistent back pain without radiological signs of vertebral osteomyelitis.
  
  
  CONCLUSIONS
  In patients with localized back pain vertebral osteomyelitis should be included in the differential diagnosis, even if there is no fever and no increase in white cell count, the erythrocyte sedimentation rate or C-reactive protein level and radiography is normal. Specific bacterial diagnosis should be made by multiple bone biopsy or blood cultures, before starting appropriate antibiotics.
authors.affiliation: Rheumatologische Universitätsklinik, Felix Platter-Spital und Universitätsspital, Basel.
authors.forename: J
authors.initials: J
authors.lastname: Lüthy
authors.forename: A
authors.initials: A
authors.lastname: Trampuz
authors.forename: A
authors.initials: A
authors.lastname: Tyndall
authors.forename: T
authors.initials: T
authors.lastname: Vogt
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D003937:Diagnosis, Differential; D015299:Discitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013530:Surgical Wound Infection / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents