Diskitis: A Prospective Diagnostic Analysis

Abstract

In a three-year prospective analysis of nine patients with suspected diskitis, seven were confirmed as having diskitis, one had sacroiliac septic arthritis, and one had Guillain-Barré syndrome. The mean age of the patients was 3.3 years, and four of the seven were girls. Routine lumbar spine roentgenograms were not diagnostic for three to eight weeks. Nuclear imaging procedures, however, produced abnormal scans in all nine studies. Technetium Tc 99m diphosphonate scans were abnormal within seven days of symptoms, gallium citrate Ga 67 scans within 14 days. Scans were abnormal on seven occasions when standard roentgenograms were not diagnostic. The diskitis patients had low-grade fever (seven), irritability (six), and leg or hip complaints (six). Early, rapid diagnosis is critical with this disease because some cases have been misdiagnosed as meningitis, appendicitis, or septic arthritis. Four of the seven patients had evidence of viral disease, white β-hemolytic streptococci and anaerobic diphtheroids were isolated from two disk space aspirates. Spica casts were used in six patients to encourage immobilization, antibiotics in two, and one patient received no specific therapy. All patients recovered regardless of therapy. The present study is the first known prospective study of diskitis. The data thus far collected suggest that this disease is more common than previously recognized and that with the use of radiopharmaceuticals, cases previously missed may now be accurately diagnosed as diskitis. Pediatricians are urged to consider this diagnosis in any child with fever, irritability, and vague abdominal, leg, or back complaints whose origin is not identified.