Suggest treatment for severe back pain

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Posted on Wed, 24 Aug 2016 in Brain and Spine
Question: My step son XXXXXXX of 18 years became very ill 6 days ago. His first symptom was severe back pain, so bad he could not move or get out of bed. Several hours later he developed a fever of 105 and was hospitalized at that time. They drew blood and spinal fluid and he was cleared of spinal meningitis, but the blood test showed high white blood cell count leading to believe of an infection of some kind. The infectious disease Doctor cleared him but thought he may have an infection around an inflamed disk in his spine after looking at the mri that was performed. Two days ago after getting more results from the blood test they told us he had salmonella poisoning and found that it was also in his stool. The doctor then told us that they were seeing fluid on his spine from the mri, but thought it may have been from drawing spinal fluid since that was done prior to the mri. He is having a second mri being done right now to check for this fluid again. The doctor also informed us today that they have ordered a gallium scan to pinpoint the location of the infection. The first day he was hospitalized last Thursday was his worst day but he doesn't seem to be improving despite all of the antibiotics he has been given. Every day he struggles with extreme shaking or cold chills followed by a fever. He had some vomiting the first day or two and some diarrhea but very little. He has not experienced any stomache or abdominal pain. Does anyone here have any suggestions because we are considering moving him to another hospital in hopes that someone else can help him better.
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Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
Intervertebral diskitis infection

Detailed Answer:
Thank you for placing your question to us on this network. That's an awful way for a young man to have to spend what could be a nice summer vacation....very sorry to hear he is suffering.....but we will hope for better days very quickly.

Your description is very thoughtful and makes perfect sense in terms of how they've worked him up and what has been happening. Infections that invade and affect the intervertebral disks are VERY DIFFICULT to treat and one must be patient with the efforts. It is sometimes a matter of weeks or even months before an infection like this can be fully cleared up. There is no doubt that this young man is ill and this is proven by the rigors or shakes....this is a nasty infection.

It sounds as if there may have also been a complication of a CSF leak that occurred as a result of the spinal tap. This is not an uncommon complication and can be easily addressed using what they call a blood patch. The consequence to that detail is a headache that he may experience every time he stands or sits up in bed. I'm sure he's not particularly interested in doing that right now anyways with the way he's feeling so I don't know how urgently his doctors feel they need to move on patching him. I would probably do it sooner rather than later just because if there is an infection in the disks that has not been brought under control yet and if there is a breach to the spinal fluid by way of this defect from the puncture then, bacterial elements and infection could get into the spinal fluid....then, there will be a meningitis and that could really make things complicated.

I would recommend that you get a neurologist on consult and keep him on the case until this young man gets out of the woods. I would move to perform the blood patch ASAP in other words.

As far as the antibiotics are concerned....if there is an infectious disease specialist on the case there is nothing more that I can possibly add to what's already being done because I am in a highly disadvantaged position giving opinions without any specific data to work with....the ID specialist is likely aware of culture results and knows exactly the species of salmonella and its sensitivity and resistance patterns to the different antibiotics, etc. As I said the LOCATION of the infection is what may be making this particularly tricky to get a hold of and control rapidly. However, if you really feel he should be moved you will want to check with the doctor in charge of the case and get their opinion on how delicate he may be to withstand a transfer.

Even the most effortless transfer from hospital to another with this type of clinical picture and having to change the entire medical and nursing staff from one group who have come to know his case to one who really knows very little is a challenge and can result in taking a step or 2 backward instead of forward. On the other hand if you have gotten the names of specialists who are renowned and highly respected for these types of cases....or if he can be transferred easily to a large TEACHING HOSPITAL or academic institution then, overall he may benefit....but that's speculation.

Remember, all the doctors working on your stepson themselves have all come from large teaching institutions and they've seen these cases before. It's the infection that's to blame for the difficulty in treatment and whether it is being done at a small community hospital vs. the best academic institution there will still be the same problems with treating an intervertebral diskitis in the face of a risk to meningitis so long as there is CSF leak.

Whatever your decision make sure you check in with his doctors and see what their thoughts are. I'm sure everyone is working their hardest to bring this under rapid control but as I said....I've personally seen cases of diskitis drag on in terms of treatments using IV antibiotics for up to 3-4 months before there was any evidence of real improvement to the point where everyone could finally breathe a XXXXXXX of relief and say, yeah.....he's over the hump. Hopefully, it won't be that long in this case....but I'm just saying these cases go from rapid resolution to very protracted. So long as he's got an ID person, a good internist, a neurologist, and a good radiologist who can do the serial studies and the gallium studies in order to localize the infection for more targeted therapy....I would say that things are in his favor....it's just Tincture of Time for the rest.

If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. Please let me know how this young man does down the road. I'd like to follow from afar and know that he's doing Ok....maybe even starting school in a few weeks? College?.....he may be slightly delayed starting the semester.....he may even wish to take this semester off from whatever....school, work, no more yardwork for a few months? LOL.....can't think of a better reason than this....kind of a dramatic way to get the time off....but oh, well! Definitely, if he's enrolled for school you may wish to talk to his doctors to see what their take is on the chances of him making it in time for a fall start if they're still battling to get the infection under control....because he's going to have a good long time to recover once the infection is cleared.

This query has utilized a total of 22 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2474 Questions

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