Central Chest Pain - An Atypical First Presentation.

Introduction: The diagnosis of thoracic spondylodiscitis is challenging, given that it is a rare entity in itself and when unusual symptoms such as central chest pain predominate on presentation, it may pose a serious diagnostic challenge.

Case Report: A 54-year-old patient presented to accident and emergency with central chest pain and elevated inflammatory markers (C- reactive protein [CRP]: 21 mg/L). Following exclusion of life-threatening cardiac causes, he was discharged home with analgesia and no formal diagnosis. Over the course of the subsequent 6 weeks, he presented to his general practitioner on two different dates with worsening chest pain alongside a new symptom of back pain and progressively rising inflammatory markers. At 6 weeks, he presented back to the emergency department with clinical signs of sepsis, mid-thoracic tenderness with weakness and altered sensation to his legs. The CRP was raised at 297 mg/L. In view of these symptoms, a contrast magnetic resonance imaging scan was performed which revealed destruction of the sixth and seventh disc space with high signal intensity on T2 and short tau inversion recovery images in T6 and T7. Blood cultures were shown to have grown Staphylococcus aureus, and the patient was subsequently treated with combined intravenous antibiotics (flucloxacillin) and oral antibiotics (rifampicin) for 15 weeks resulting in complete resolution of his symptoms.

Conclusion: Our case report highlights the need for a high index of suspicion of spondylodiscitis in patients presenting with central chest pain, unresolving back pain and elevated inflammatory markers especially in the absence of any other formal diagnosis.