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Lesson of the month
Intervertebral discitis presenting as oligoarthritis
  1. A T Marshall1,
  2. J K Gaffney1,
  3. T J Marshall2,
  4. H M S Williams3
  1. 1Department of Rheumatology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK
  2. 2Department of Radiology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK
  3. 3Public Health Laboratory Service, Norfolk and Norwich University Health Care Trust, Bowthorpe Road, Norwich, Norfolk NR2 3TX, UK
  1. Correspondence to:
    Dr A T Marshall;
    t.marshalluea.ac.uk

https://doi.org/10.1136/ard.2002.001586

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    The symptoms of intervertebral discitis may be indistinct, making diagnosis difficult. The onset may be acute or insidious, and radicular or spinal compressive symptoms and signs may be present. Purulent infection may spread to surrounding soft tissues, and epidural abscess formation is recognised. Long term neurological sequelae may result, and mortality of between 7% and 18% has been reported.1,2 Vigilance is required if the diagnosis is to be made early, and treatment should be of adequate duration to reduce the rate of recurrent infection. To our knowledge, this is the first report of a case of intervertebral discitis in a patient presenting with an oligoarthritis.

    CASE REPORT

    A 62 year old woman was referred with a 2 week history of oligoarthritis and fever. She had developed acute back pain with fever 12 hours after visiting a spa in Italy. On returning home, her back symptoms resolved, but she developed persistent fever with pain and swelling of both knees, left ankle, and left hip. There was no significant past medical history. On examination, her temperature was 39°C. She had a full range of spinal movements and no spinal tenderness, but had synovitis of both knees, left hip, and left ankle. Her throat was hyperaemic. Examination was otherwise unremarkable. …

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    Footnotes

    • Series editor: Anthony D Woolf