2009 Southern Regional Meeting Abstracts

Case Report: Introduction: Diskitis, inflammation or infection of the intervertebral disc space or veretebral endplate, is an uncommon condition in the pediatric population. This condition has varied clinical presentations with the most common as back pain and refusal to walk. Abdominal pain or pelvic pain is an unusual presentation for this condition particularly among toddlers. Case report: We report a previously healthy 3-year old African American female who presented with a two week history of intermittent abdominal pain. Suspicion for intussusception by the primary care physician prompted an admission for observation. Laboratory work-up which included a complete blood count, comprehensive metabolic panel, and urinalysis were normal. Blood and urine cultures were negative. The only abnormal laboratory finding was an elevated erythrocyte sedimentation rate at 56 mm/hr. An abdominal radiograph was unremarkable for obstruction or other abnormality. Although this patient was toilet trained prior, fecal and urinary incontinence were noted within 24 hours of hospitalization. Subsequently, the patient demonstrated difficulty ambulating with the recurrence of lower abdominal pain and unilateral tip-toeing on the left to alleviate the pain. The patient remained afebrile, and there were not other abnormal clinical findings. A MRI of the spine was performed and findings were consistent with diskitis at the level of L3/L4 with an associated epidural abscess. She completed prolonged intravenous antibiotics with complete resolution of symptoms and radiologic findings. Discussion: This case illustrates the need to include diskitis as a possible diagnosis in toddlers with abdominal pain and sudden onset of incontinence.