Fever of unknown origin in a patient initially presenting with traveller's diarrhoea.
A 17-year-old male presented with diarrhoea and malaise following his return from Kenya and Tunisia. He was managed as a case of traveller's diarrhoea. Stool cultures were negative for pathogenic bacterial growth. Two weeks later he presented with worsening lower back pain. MRI of lumbosacral spine suggested L1 osteomyelitis. CT-guided spinal aspirate grew no organisms and repeat viral serology and blood cultures (including tuberculosis screening) were negative. He was treated with a 6-week course of ceftriaxone. Back pain did not improve and a repeat MRI scan 8 weeks after his antibiotic course indicated progressive changes in L1 extending to L2 with an intradiscal abscess. Repeat CT-guided spinal aspirate grew Salmonella arizonae sensitive to cotrimoxazole and ceftriaxone. He was treated with intravenous ceftriaxone and cotrimoxazole for 12 weeks. A 4-month follow-up MRI scan showed progressive improvement of the L1/L2 discitis with resolution of intradiscal fluid.
Royal Bournemouth Hospital, Bournemouth, UK.
Malik Asif
http://orcid.org/0000-0003-3313-303X
MA
Humayun
Royal Bournemouth Hospital, Bournemouth, UK.
Tristan
http://orcid.org/0000-0001-7505-7843
T
Richardson
Royal Bournemouth Hospital, Bournemouth, UK.
Augustin
A
Brooks
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D020802:Epidural Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D005335:Fever of Unknown Origin / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007630:Kenya; D017116:Low Back Pain / Q000150:complications / Q000382:microbiology*; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012480:Salmonella Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D014195:Travel; D016896:Treatment Outcome; D014416:Tunisia
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone
Minerva Chir. 2004 Feb;59(1):75-8
15111836
Am Fam Physician. 2005 Jun 1;71(11):2095-100
15952437
J Rheumatol. 1991 Sep;18(9):1328-31
1757933
Arch Intern Med. 1988 May;148(5):1207-10
3365088
Am J Public Health. 1990 Mar;80(3):286-9
2305906
South Med J. 2005 Nov;98(11):1123-9
16351033
Spine (Phila Pa 1976). 2010 Nov 1;35(23):E1317-21
20938384
Am J Gastroenterol. 1989 Apr;84(4):433-5
2929568
N Engl J Med. 1980 Aug 14;303(7):360-70
6993944
J Bone Joint Surg Am. 1997 Jun;79(6):874-80
9199385
BMJ. 2016 Apr 19;353:i1937
27094342