title: Spontaneous septic arthritis of the lumbar facet caused by methicillin-resistant Staphylococcus aureus in an otherwise healthy adolescent.
abstract: We report the case of a 16-year-old boy with isolated septic arthritis of a lumbar facet. This rare presentation of an infection in a lumbar facet joint occurred after minor trauma sustained in a football game. Septic arthritis of the spinal facet joint is an uncommon phenomenon. Only 5 cases have been reported in immunocompromised pediatric patients. To our knowledge, no case of septic arthritis in an immunocompetent pediatric patient has been reported. An otherwise healthy 16-year-old boy presented with 4 weeks of escalating back pain after a minor athletics-related trauma. Evaluation showed incapacitating pain, lumbar musculature spasms, and the absence of fever, hemodynamic, or neurologic changes. Laboratory values were within normal limits. Magnetic resonance images showed a fluid collection within the L3-L4 facet and a localized abscess. Computed tomographic-guided aspiration showed methicillin-resistant Staphylococcus aureus infection, for which the patient received 6 weeks of vancomycin with complete resolution of symptoms. Refractory lumbago in an adolescent requires careful evaluation.
authors.affiliation: Albany Medical Center, Albany, NY. papalid@mail.amc.edu.
authors.forename: Dean N
authors.initials: DN
authors.lastname: Papaliodis
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Roberts
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Richardson
authors.forename: James B
authors.initials: JB
authors.lastname: Lawrence
mesh_terms: D000293:Adolescent; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D001265:Athletic Injuries / Q000150:complications* / Q000175:diagnosis; D005538:Football / Q000293:injuries; D006801:Humans; D007121:Immunocompetence; D008159:Lumbar Vertebrae / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D021801:Zygapophyseal Joint / Q000382:microbiology*