Title : From gut to spine: From traveller’s diarrhoea to discitis and osteomyelitis
Abstract:
A 67-year-old man presenting repeatedly with fever, diarrhoea, and progressive thoracic back pain following recent travel. Blood cultures confirmed Salmonella Java bacteraemia. Initial Computed Tomography (CT) was unremarkable. Due to persistent symptoms, repeat CT angiography demonstrated vertebral destruction, and Magnetic Resonance Imaging (MRI) confirmed T6–T7 discitis and osteomyelitis with prevertebral soft tissue involvement. There was no evidence of aortitis or infective endocarditis.
Management required prolonged antimicrobial therapy with several adjustments guided by susceptibility testing and tolerance, including intravenous ceftriaxone followed by oral therapy. Treatment duration was extended to six months following specialist advice. The patient showed significant clinical improvement with resolution of systemic symptoms and reduced back pain, and serial imaging demonstrated no vertebral collapse.
This case highlights that Salmonella Java can cause invasive spinal infection in the absence of traditional immunocompromising conditions. Persistent back pain in the context of Salmonella bacteraemia should prompt early spinal imaging to avoid diagnostic delay. Prolonged, individualised antimicrobial therapy and multidisciplinary management are essential to optimise outcomes.
