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Answers on p 349.
A 4 year old boy was brought with history of low back pain of seven days' duration after a trivial fall. On examination the child had tenderness in the lower lumbar spine. There was no paraspinal swelling or spinal deformity. The spinal movements were globally restricted and there was no regional lymphadenopathy or any neurovascular deficit. Systemic examination revealed no abnormality. Plain radiographs of the spine revealed a collapse of the L3 and osteopenia of L4 vertebral body (fig 1A and B). Haematological investigations showed a haemoglobin concentration of 100 g/l, leucocyte count of 7.2 × 109/l (polymorphs 83%, lymphocytes 12%, and eosinophils 4%), and an erythrocyte sedimentation rate of 70 mm at one hour. The child did not attend follow up for a month, but later presented with insidious onset high grade fever not responding to salicylates. On examination of the abdomen, the liver was just palpable. There was no splenomegaly; however, the cervical lymph nodes were palpable. Repeat radiographs showed collapse of D9, D11, L2, L3 vertebral bodies (fig 2A, B, and C). A haemogram showed anaemia (haemoglobin 50 g/l), leucocyte count 12.7 × 109/l (polymorphs 22%, lymphocytes 76%, eosinophils 2%).
- What is the differential diagnosis?
- What further investigations should be performed?
- What is the treatment of this condition?
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