Acute Symptomatic Calcific Discitis Mimicking a Septic Spondylodiscitis

Abstract

Acute symptomatic calcific discitis is a poorly understood condition that has been mostly reported in children. Cases in adults have been scarcely reported and may mimic an infectious process. Imaging, including computed tomography, can show the disc calcification but might fail to show it because its resorption can occur early after the onset of symptoms. We report the case of an adult patient presenting with severe cervical-dorsal junction pain, fever, high C-reactive protein (CRP) levels, and imaging findings mimicking an infectious spondylodiscitis, including an erosion of the anterior part of the vertebral endplate. However, the patient improved spontaneously and rapidly, with pain and fever disappearing and C-reactive protein (CRP) returning to normal within a week.

Infective discitis with concurrent calcific discitis masquerading as renal colic

“…However, an infective process may additionally demonstrate diffuse oedema and contrast enhancement of vertebral bodies. It is suggested that calcification of the nucleus pulposus on CT is crucial to the diagnosis of calcific discitis; 1,2 however, in this case, it allayed suspicion of an infective process. This case suggests extrusion of calcific material may coincide with an infective discitis.…”

“…Disc calcifications are usually asymptomatic; however, if they extrude into surrounding tissues, they induce acute pain and inflammation. Symptomatic calcific discitis is clinically indistinguishable from infective discitis, with both conditions manifesting fever and elevated inflammatory markers 1,2 . In patients with symptomatic calcific discitis, they often spontaneously improve within a week.…”

“…In patients with symptomatic calcific discitis, they often spontaneously improve within a week. Calcific discitis has a predilection for the mid‐lower thoracic region, rarely afflicting the lumbar spine; 1 hence, a degree of suspicion should arise in the clinician when calcific discitis is diagnosed in the lumbar region.…”

“…Differential diagnoses include infective discitis, neoplasia, metastatic deposits, tuberculosis (Potts disease), and synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Before evidence of radiographic calcification, the only clue of calcific discitis on MRI may be disc swelling associated with a diffuse and reactive oedema of the vertebral end plates 1 . Contrast enhancement of the vertebral body may occur in calcific discitis if there is an associated vertebral body herniation of calcific material 2 .…”