Abstract
Background Discitis is an infection of the intervertebral disc space that can lead to paralysis, sepsis, epidural abscess, or other life-threatening complications if left untreated and may sometimes present with limited laboratory abnormalities and symptoms to clue a diagnosis. Hematogenous spreading of microorganisms from an infectious site is the most common pathophysiologic cause of vertebral discitis. Case Presentation A 68-year-old female presented to the Medical Assessment Unit (MAU) with a two-week history of increased micturition frequency, dysuria, and constant, dull lower abdominal pain radiating to the left flank. She experienced one episode of fever with chills and rigor, accompanied by myalgia and lethargy that rendered her bedridden. Despite two courses of antibiotics (Pivmecillinam and Nitrofurantoin), her symptoms persisted. Her medical history included hypertension and arthritis. Examination revealed tenderness in the right iliac fossa and hypogastrium, with elevated WCC (15.3), neutrophils, and CRP (299). Initial treatment targeted pyelonephritis/recurrent UTIs. Persistent temperature spikes led to a microbiology consultation and IV Tazocin administration. Despite unremarkable ultrasound and CT findings, her condition did not improve. Further examination revealed lower spinal tenderness with paraspinal spasms. Investigations and Treatment An MRI of the spine identified multifocal inflammation indicative of an epidural collection and early discitis. She was treated for discitis with IV antibiotics over six weeks, resulting in full recovery without neurological complications. Conclusion This case highlights the critical need to consider discitis in elderly with unexplained fever and nonspecific symptoms. Discitis, a rare and often misdiagnosed infection, can subtly present, delaying diagnosis and treatment. Early recognition and intervention are vital to prevent severe complications like chronic pain or neurological deficits. Heightened clinical suspicion and comprehensive diagnostic evaluation in atypical presentations ensure timely intervention and improved patient outcomes, emphasizing the importance of a thorough and vigilant diagnostic approach.