Clinical and Laboratory Characteristics of Infective Endocarditis When Associated with Spondylodiscitis

Abstract

Spondylodiscitis is rarely observed in association with infective endocarditis (IE). In the study presented here, 92 cases of definite IE were examined. Spondylodiscitis was present in 14 (15%) cases. The mean age of patients with spondylodiscitis was 69.1+/-13.6 years (range, 33-87 years). The male-to-female ratio was 8:6. Predisposing heart disease was found in nine (64.3%) cases. Back pain was reported in all cases. Spondylodiscitis was diagnosed before endocarditis in all cases. The infection affected the lumbar spine in 10 (71%) cases. A bacterium was isolated in all cases: group D Streptococcus ( n=5; 35.7%), coagulase-negative Staphylococcus ( n=4; 28.6%), and others ( n=5). Endocarditis affected predominantly the aortic valve (43%). The outcome was favourable in 12 cases. No differences in clinical features, evolution of disease, or laboratory values were found between IE patients with and IE patients without spondylodiscitis. Spondylodiscitis does not appear to worsen prognosis of IE, although the need for cardiac valve replacement seems to be more frequent in IE patients with spondylodiscitis. IE should be included in the differential diagnosis in patients with infectious spondylodiscitis and risk factors for endocarditis. In such patients, echocardiography should be performed routinely.

Only Spondylodiscitis? A Clinical Case of Multiple Septic Embolization

“…The first was reported by Sèze et al [8]. Le Moal et al [9] reported that the prevalence of spondylodiscitis in patients with IE was of 15%. Spondylodiscitis, has rarely been described, particularly in case reports.…”

“…A careful review of the patient's history and physical examination, as well as laboratory data and diagnostic imaging studies are necessary. Musculoskeletal symptoms can represent the major sign of the disease, leading to diagnostic difficulties [9].…”

Spondylodiscitis and endocarditis caused by S. vestibularis

“…Le Moal et al 12 reported that the prevalence of spondylodiscitis in patients with IE was of 15%. Spondylodiscitis, however, has rarely been described, partic- Spondylodiscitis and endocarditis caused by S. vestibularis ularly in case reports.…”

“…Usually, the patient presents with decreased range of motion and spinal tenderness. 12 As regards the pathogenesis, some authors have suggested that back pain is due to microemboli of immune complexes with or without bacteria. 15 The lumbar region is most commonly involved (60%), and thoracic spine can also be affected (26%).…”

“…Musculoskeletal symptoms can represent the major sign of the disease, leading to diagnostic diffi culties. 12 Musculoskeletal symptoms are common complaints, especially in the aging population. These similar symptoms also occur in up to 45% of patients with IE and are often misdiagnosed as rheumatic or degenerative joint disease.…”