CARE-checklist-Delayed diagnosis in spondylodiscitis secondary to an underlying condition; a two-case report.

AbstractBackground:Delayed diagnosis of spondylodiscitis (DDS) is related to a poor functional prognos. It is often reported in immunodeficient patients such as elderly patients or those with chronic inflammatory disease. Only few cases of DDS were reported in patients with other chronic neurological or common conditions. We report two cases that were initially misdiagnosed in a patient with a chronic neurological disease and a pregnant woman.Case presentation:We present the case of a female 23-year-old patient diagnosed with Friedriech's ataxia. She consulted for rapid onset of gait disorder, which was at first related to her neurological disease evolution. Only two weeks later, when she presented with complete paraplegia, CT scan showed dorsal vertebral dislocation as well as pre and retro vertebral abscesses complicated with spinal cord compression. She was then diagnosed with tuberculous spondylodiscitis. The significant vertebral damage and the underlying neurological pathology made the functional prognosis poor.The second case is 34-year-old woman, pregnant at 34 weeks who presented with a one-month history of low back pain. No abnormality was noticed upon her clinical examination and X-rays which lead to the diagnosis of common low back pain worsening upon pregnancy. It was only at the worsening of symptoms and the difficulty walking that further MRI imagery suggested spondylodiscitis. She had appropriate medication for the rest of her pregnancy, wich happened without complications. After delivery she had surgery for the purpose of stabiling the spine in order to prevent neurological complications from worsening.Conclusion:The diagnosis of tuberculous spondylodiscitis may be delayed because of an underlying coondition. This delay worsens the functional prognosis in neurological patients who already present with deficits.