Streptococcus Intermedius Spondylodiscitis: An Unusual Presentation of Acute Back Pain in an Elderly Gentleman With Parkinson’s Disease

Abstract

Back pain is a common problem affecting approximately one-third of the UK adult population each year with the etiology in older people commonly attributed to osteoporosis and spondylosis. Uncommon causes, such as spondylodiscitis, can potentially cause significant complications, therefore early diagnosis and management are imperative. We present an unusual case of back pain in an elderly gentleman with Parkinson's disease (PD) attributed to Streptococcus intermedius spondylodiscitis. A 73-year-old gentleman presented with non-specific chest and abdominal pain. Inflammatory markers were elevated, consolidation demonstrated on chest X-ray, and antibiotics were commenced. Patient suffers from PD managed with selegiline, stalevo, and a self-administered apomorphine subcutaneous pump. He developed a constant severe lower back pain without neurological deficit. Streptococcus intermedius was identified on blood culture and common sources were excluded. Magnetic resonance imaging and minimal-preparation computed tomography (CT) confirmed intervertebral spondylodiscitis. A conservative approach with combination antibiotics and rehabilitation was undertaken and the patient returned to his previous functional level. We report an unusual case of spondylodiscitis in an elderly gentleman with PD. The initial presentation of radicular pain, unusual causative agent isolated, and the likely source of infection from the apomorphine pump highlight the importance of clinical suspicion, early diagnosis and management of patients with spondylodiscitis.