An urgent spine MRI was requested. This revealed left L3/4 and L4/5 facet joint septic arthritis with an associated epidural collection and fluid accumulation in the left erector spinae muscle.
A subsequent MRI with contrast showed progression, with osteomyelitis, diffuse myositis, and evidence of secondary infectious foci at the T2/3 intervertebral disc and T6/7 facet joint.
His laboratory findings included an elevated CRP with a normal white cell count, highlighting the possibility of “silent” infection without marked systemic signs.
His management included:
- an urgent orthopaedic review
- IV ceftriaxone initially followed by several weeks of IV clindamycin via a PICC line
- a decision to avoid surgical intervention due to the absence of cauda equina or significant cord compression
- serial MRIs for nearly 10 months to monitor resolution
- physiotherapy following clinical improvement.
