Linezolid therapy for pediatric thoracic spondylodiscitis due to Staphylococcus aureus sepsis

We report the case of an immunocompetent child with spondylodiscitis as a result of staphylococcal sepsis, which was successfully treated with linezolid. The patient was admitted with fever and circumferential swelling in the paradorsal region, which was evident only in the flexed back position. A chest X-ray showed a pleural effusion with pneumonitis and dorsal kyphosis. Following the yield of Staphylococcus aureus from blood cultures, the initial therapy of ceftriaxone and amikacin was changed to vancomycin. However, the dorsal swelling increased further and imaging investigations showed destruction of the vertebral bodies D8-D10 and surrounding tissue swelling. Vancomycin was changed to linezolid, and the patient began to improve; a full recovery was made. Our case suggests that even if spondylodiscitis is rare in the pediatric age-group, particularly as a complication of staphylococcal sepsis, early diagnosis and prompt and appropriate therapy are important to prevent severe complications. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.