Rare, post-periodontitis spondylodiscitis caused byFusobacterium nucleatumin a patient with multiple sclerosis: challenge of diagnosis and treatment

Abstract

Fusobacterium nucleatum is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2–L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew F. nucleatum. Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by F. nucleatum is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.

Isolated Fusobacterium nucleatum Growth in the Blood Culture of a Middle-Aged Man With Lumbar Discitis, Surrounding Psoas Abscesses, and an Inferior Vena Cava Thrombus

“…Of the 27 identified publications, the authors found 15 published reports of discitis or NVO attributable exclusively to F. nucleatum [5][6][7][8]. To our knowledge, this is the first with an IVC thrombus.…”

“…A significant proportion of F . nucleatum -associated NVO cases suggest origins of infection arising from the oropharyngeal, respiratory, or dental routes [ 6 - 9 ]. Dissemination of F .…”

“…F . nucleatum is also known to cause periodontitis; therefore, another possible aetiology is seeding to the lumbar region from the oral cavity [ 6 ]. There were no concerns about our patient's oral hygiene so this was deemed a less likely infection source.…”

“…Specifically, CT of the head with contrast study is an optimal choice to investigate for oropharyngeal infections [ 12 ]. We also suggest taking a thorough dental history and examination [ 6 , 9 ].…”

“…Whilst some patients were immunocompromised, many were not. A significant proportion of F. nucleatum-associated NVO cases suggest origins of infection arising from the oropharyngeal, respiratory, or dental routes [6][7][8][9]. Dissemination of F. nucleatum appears to be due to its ability to bind with and invade host cells via a specific adhesin FadA, which is regarded as one of its virulence factors [4,10].…”