Infectious discitis and osteodiscitis in children are rare. The usual age of occurrence is between two and five years. The diagnosis is most often delayed due to mild presenting symptoms. We present the case of a five and half year old child who presented with progressively worsening lower back pain over a period of two weeks, which was made worse with bending forward. He did not have fever, pain in his lower extremities, or any other accompanying symptoms. He did not have a history of recent illnesses or trauma to the lower back. The laboratory work revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and rest of the parameters were within normal limits. CT scan of his spine showed findings of well-defined defects on the endplates of L4-L5 with prevertebral soft tissue thickening. MRI with and without contrast of the spine confirmed the findings and detected mild focal erosive changes at the opposing endplates of L4-L5 with disc space narrowing, thin fluid along the anterior margin of the disc, and shallow disc bulging, which were consistent with osteodiscitis. A conservative approach with intravenous antibiotics followed by a switch to oral antibiotics was undertaken with good clinical recovery. Treatment strategy for osteodiscitis in children is generally antibiotic therapy. Prognosis in children is good. In some cases based on the pain severity, other measures such as bed rest, analgesics, and casting for immobilization may be required. Biopsy tends to be reserved in uncertain cases or in those that have poor response to pain control measures and antibiotics.
A nine-day-old male infant presents with his mother to the pediatric clinic with a concern of a white spot in his right eye. There was no history of antenatal or perinatal complications and the mother's serology was negative. Physical examination was remarkable only for leukocoria in the right eye. He was evaluated to have a Mittendorf dot. This is a benign clinical finding. Pupillary reflex check is an important part of a physical examination which can recognise pathological conditions such as cataract, retinoblastoma, metabolic errors with ocular manifestations and lead to early treatment before the child loses vision.
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