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Low back pain at presentation in a newly diagnosed diabetic

East London Centre for Paediatric and Adolescent Diabetes at Royal London Hospital, Whitechapel E1 1BB, and Newham General Hospital, Glen Road, Plaistow E13 8SL, UK

Correspondence to:
Correspondence to:
Dr S Ladhani, Department of Paediatrics, Newham General Hospital, Glen Road, Plaistow E13 8SL, UK;
DrShamez{at}aol.com

ABSTRACT
Insulin dependent diabetes mellitus predisposes to a range of different and unusual infections, including epidural and psoas abscesses. However, they occur mainly in adults with longstanding diabetes. We report the case of a 12 year old boy who presented with diabetic ketoacidosis and low back pain, and was subsequently diagnosed with both a left psoas abscess and an extensive thoracolumbar spinal epidural abscess measuring 20 cm in length. This case report highlights the need to maintain a high index of suspicion for epidural abscesses in children presenting with fever and localised back pain. Early diagnosis with appropriate imaging and aggressive management can prevent development of permanent neurological damage as was the case in our patient.

Keywords: Staphylococcus aureus; psoas abscess; spinal epidural abscess

Abbreviations: ESR, erythrocyte sedimentation rate; IDDM, insulin dependent diabetes mellitus; MRI, magnetic resonance imaging; SEA, spinal epidural abscess