title: Spondylodiscitis associated with multiple level involvement and negative microbiological tests: an unusual case.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  To report an unusual case of spondylodiscitis with multiple level involvement.
  
  
  BACKGROUND
  Spondylodiscitis, an infection of the intervertebral disc space, vertebral bodies, or the paraspinal epidural space can be a serious disease because of diagnostic delay and inadequate treatment.
  
  
  METHODS
  A previously healthy, 52-year-old man was presented to our outpatient clinic with a complaint of acute, atraumatic onset of severe back pain for more than 1 month. Initially, he was misdiagnosed at another clinic as myofascial pain and treated with nonsteroidal anti-inflammatories and physical therapy, which he did not benefit from. He never complained of fever; however, laboratory tests revealed raised erythrocyte sedimentation values, increased C-reactive protein values but normal leukocyte count. Thoracal and lumbal plain radiographs were nonspecific. Magnetic resonance imaging demonstrated increased signal intensity in vertebral bodies and intervertebral disc space through T12-L4 and in the paravertebral musculature at L2-L3 with contrast enhancement. Blood cultures and computed tomography-guided needle biopsy and cultures were negative.
  
  
  RESULTS
  The patient was treated with oral amoxicillin and clavulanate and responded very well clinically; however, imaging examinations were repeated up to 6 months because of multilevel involvement. Follow-up magnetic resonance imaging findings at 3 months and 6 months showed decreased signal intensity, and luckily, there was no evidence of vertebral destruction.
  
  
  CONCLUSIONS
  Diagnosis of spondylodiscitis could be challenging and commonly missed; however, it should always be included in the differential diagnoses of back pain in the middle aged and healthy population.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Bahcelievler, Ankara 06490, Turkey. oyaumit@hotmail.com
authors.forename: Oya Umit
authors.initials: OU
authors.lastname: Yemisci
authors.forename: Sacide Nur Saracgil
authors.initials: SN
authors.lastname: Cosar
authors.forename: Pnar
authors.initials: P
authors.lastname: Oztop
authors.forename: Metin
authors.initials: M
authors.lastname: Karatas
mesh_terms: D000284:Administration, Oral; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D001416:Back Pain / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D015299:Discitis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007958:Leukocyte Count; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019980:Amoxicillin-Potassium Clavulanate Combination; D002097:C-Reactive Protein