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Discopathy at 14 years, Propionibacterium acnes, growth

Our 14-year-old teen with cystic fibrosis experienced severe back pain in May-June.
He finally performed an MRI in August with this result: On the contrary, there exists in L4-L5 and L5-S1 a disc-shaped bulge with no disco-radicular conflict or a repercussion on the foramens. The bulge predominates in L4-L5. Preservation of the water signal of the disc. The analysis of the medullary cord does not find an anomaly of the cervico-occipital hinge, no bone marrow attached. No spinal signal abnormality.
By investigating a little, and limiting myself to reliable sources, I realized that I had not understood the rarity of the case of (double) discopathy at this age.
What particularly disturbs me is to find neither cause nor trauma to explain his condition.
Two doctors (general practitioners) of my friends told me that the youngest patients diagnosed with discopathy were 17-18 years old, but that it was really rare (3-4 cases). And 14 years, never.
One of them poses, with great precaution, the question of a link, more direct than one might think, with his CF.
It recalls a hypothesis that was relayed by all media for 48 hours when it was "released" in 2013.
These are two studies published in The European Spine Journal that hypothesize a bacterium causes low back pain and hernias, namely Propionibacterium acnes.
These are the observations and the questions we ask ourselves:
- CF is a rare disease.
- a painful double-discopathy when one is a teenager, it is even rarer, it seems. (I did not find any figures).
Even if we are aware that the CF is not protective for anything else, we can nevertheless find that the probability of having the two situations without any link between them is extremely low.
I cannot dwell on the nature of this link:
- bacteriological,
- iatrogenic (and here I think of the different treatments and the respiratory physiotherapy with great repeated hyperpressions),
- secondary environmental?
The case of my son does not justify a biopsy to answer the hypothesis of the presence or not of Propionibacterium acnes, but is the taking of the antibiotic evoked possible?
About the ventoline to confirm a case of asthma: if the remedy works, it is that the presumed cause was the right one.
It is probably extremely simplistic.
I am also making the observation, probably simplistic again, that this germ, Propionibacterium acnes, is a bacterium linked to acne, and that the double-discopathy of my son appears in full adolescence. Suspecting a link may be very hasty, but I do not know about the possibilities of circulating this bacterium in the human body.
Source really serious and complete (but long), very convincing:
Very popular article (but short!):
Reference studies:
- (Euronextine): a double-blind randomized clinical controlled trial of efficacy, Eur Spine J. (Apr. 22, 2006) (4): 697-707. Doi: 10.1007 / s00586-013-2675-y
- Is low back pain after disc herniation with Modic Type 1 changes a low-grade infection ?, Eur Spine J. 2013 Apr; 22 (4): 697-707. Doi: 10.1007 / s00586-013-2736-2
The hypothesis is recent (2013), but the figures are actually very troubling on the rate of Propionibacterium Acnes in patients with back pain or discopathy.
Another explanation is envisaged by the physiotherapist who follows our son: as part of his growth, his muscles would be "short". I understand the idea, but I do not think it can explain the magnitude of the problems. The physiotherapist showed him stretches to do regularly.
I am not looking for an answer on the possible link between CF and the presence of Propionibacterium acnes, it is a matter of large studies. I just wanted to emphasize that the assumption of its presence cannot be excluded from the outset.
My questions are:
- If one accepts the possibility of the presence of Propionibacterium acnes, and if the condition of the back of my son is not stable, can / should it be envisaged placing under antibio "to see"? How to measure whether his condition is stable or evolutionary? Should a new review be scheduled within a timeframe? Are bone problems related to cystic fibrosis itself considered?
- Is the explanation of the physiotherapist possible to explain a phenomenon of this magnitude?
Thank you in advance for your time.
You are asking a very well-documented question but for which I have no relevant answer.
If the infectious discopathies related to a Propionibacterium acnes, germ found in acne samples have been the subject of publications I have not found in the scientific literature cases or arguments that can explain a link with cystic fibrosis.
It seems wise, before considering a therapeutic solution, to consult in an establishment able to mobilize experts in rheumatology, infectiology and cystic fibrosis to discuss the case of your son.
To direct you to such an institution according to your place of residence, I suggest you get closer to the doctor of the CRCM who follows your child or to contact the medical department of the French CF Patient Organization Vaincre la Mucoviscidose.
Sorry for not being able to answer your questions satisfactorily.
Best regards,
Gilles RAULT, MD, Roscoff CF Center