Pyogenic Spondylodiscitis due to Streptococcus constellatus in an Immunocompromised Male Patient: A Case Report and Review of the Literature

Abstract

Pyogenic spondylodiscitis is a primary infection of the intervertebral disc and is a rare entity. Here, we describe the case of a 64-year-old male patient, a professional breeder, who attended the Emergency Department with sciatica and back pain that was worsening for a week. The patient had no history of surgery or trauma. The patient had poor oral hygiene. Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood cultures revealed Streptococcus constellatus. The patient was initially treated with vancomycin but due to renal failure deterioration, the treatment was changed to daptomycin for 8 weeks. During hospitalization, he endured renal injury and nosocomial respiratory tract infection. The patient was discharged with no further complications. Follow-up revealed improvement of neurological signs. In our case, it seems that poor oral hygiene was the cause of bacteremia, which underlies the importance of a good oral health status in immunocompromised patients not only to prevent but also to successfully eliminate any dental source of infection. S. constellatus is an extremely rare pathogen and to our knowledge only two other cases of pyogenic spondylodiscitis are reported in the literature. Early diagnosis is very important for the prognosis of these patients.

Aggressive Pyogenic Spondylitis Caused by S. constellatus: A Case Report

“…The patient was successfully treated conservatively with antibiotics and the likely source of infection was dental disease. The case of pyogenic spondylodiscitis due to poor oral health and which was caused by SC was also described by Potsios et al [ 14 ]. This was a 64-year-old immunocompromised male patient presenting with sciatica and back pain and was also effectively treated with antibiotics.…”

“…To the best of our knowledge, and based on the review of the published literature, similar cases of pyogenic paracostal and paravertebral abscesses were not yet described. There are only a handful of case reports reporting pyogenic spondylitis caused by SC [ 10 , 11 , 12 , 13 , 14 ]. The case that was similar the most in the published literature was by Jin and Yin in which they presented a patient diagnosed with pyogenic spondylitis caused by SC [ 10 ].…”

Acute Pyogenic Spondylitis Caused by Streptococcus Constellatus in an Obese Patient: A Case Report

“…3 In addition, Lim et al reported one case of S. constellatus -induced spondylodiscitis in a 14-year-old male, 4 and Potsios et al reported another case of S. constellatus -induced PS in a 64-year-old immunocompromised male patient. 5 All of these cases recovered after surgery or 6–8 weeks of antibiotic treatment.…”

“…1 Staphylococcus aureus is the most common causative pathogen of PS, whereas PS induced by Streptococcus constellatus (S. constellatus), which is found in the normal flora of the upper respiratory, digestive and reproductive tracts, is very rare. [2][3][4][5] Herein, we describe an extremely rare case of rapid progress of PS related to S. constellatus in an obese patient.…”