Complicated Spondylodiscitis Caused by Pseudomonas aeruginosa in a Healthy Teenager: A Case Report and Literature Review

Pediatric spondylodiscitis (PSD) is a rare but potentially serious infection of the intervertebral disc and adjacent vertebral endplates. Its insidious onset and nonspecific presentation often result in delayed diagnosis, increasing the risk of complications such as vertebral destruction, abscess formation, spinal deformity, and neurological deficits. While Staphylococcus aureus and Kingella kingae are the most commonly reported pathogens, Pseudomonas aeruginosa is exceedingly rare in otherwise healthy children. We report a previously healthy 16-year-old male presenting with persistent lower back pain, intermittent fever, and gait disturbance. MRI revealed D12-L1 spondylodiscitis with bilateral psoas abscesses. Despite broad-spectrum empirical antibiotics, his condition worsened, and blood cultures remained negative. Thirty-two days after admission, a CT-guided abscess biopsy identified P. aeruginosa, enabling targeted therapy with piperacillin-tazobactam and aminoglycosides, which led to rapid clinical improvement. Due to progressive thoracolumbar kyphosis, percutaneous posterior spinal stabilization (D10-L2) was performed. The patient completed a six-week antibiotic regimen and physiotherapy, achieving full recovery without residual disability. PSD is challenging to diagnose because of its nonspecific clinical presentation, with reported diagnostic delays averaging four to five weeks. Culture-negative infections are frequent, complicating empirical treatment. P. aeruginosa is an exceptionally rare pathogen in PSD, with only two previous cases reported, typically associated with immunosuppression, prior surgery, or contiguous spread. This case highlights the critical role of early imaging and high clinical suspicion in adolescents with persistent back pain unresponsive to standard therapy. Image-guided biopsy of paravertebral or psoas abscesses significantly increases pathogen detection, facilitating effective targeted antimicrobial therapy. Surgical stabilization is warranted in cases of progressive vertebral destruction or spinal instability. Multidisciplinary management is essential for optimal outcomes. Early recognition of PSD, prompt imaging, and targeted biopsy when empirical therapy fails are key to accurate pathogen identification. Timely, pathogen-specific antimicrobial therapy, combined with surgical intervention when indicated, can prevent long-term complications and ensure full recovery in affected children.