A Case of Infective Endocarditis Occurred during Treatment for Infectious Spondylitis Accompanied by Peptostreptococcus Anaerobius Bacteremia

Article information

Kosin Med J. 2012;27(2):185-190
Publication date (electronic) : 2012 December 27
doi : https://doi.org/10.7180/kmj.2012.27.2.185
1Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea.
2Department of Cardiology, College of Medicine, Kosin University, Busan, Korea.
Corresponding Author: Joon Hoon Jeong, Department of Internal Medicine, Wallace Memorial Baptist Hospital, 374-75 Namsan-dong, Geumjeong-gu, Busan 609-728, Korea. TEL: +82-51-580-1202, FAX: +82-51-583-7114, jjhoon69@yahoo.co.kr
Received 2012 July 10; Revised 2012 September 14; Accepted 2012 October 17.

Abstract

It is necessary to distinguish between pyogenic and tuberculous spondylitis of infectious spondylitis, if it is pyogenic spondylitis, antimicrobial therapy should be directed against an identified microorganism and clinical assessment should be done at 4 weeks. But if microorganism is a anaerobic bacteria, especially Peptostreptococcus anaerobius, combination antibiotic therapy should be considered bacause it may be a component of mixed infections as a passenger and have abilities to induce abscesses, other bacterial growth as a synergy effect. In addition, echocardiography may be necessary because pyogenic spondylitis is associated with infective endocarditis about 12%. We report a 64-year-old man who was treated for infectious spondylitis accompanied by Peptostreptococcus anaerobius bacteremia, but had to undergo heart surgery because an attack of infective endocarditis with systemic embolism during hospitalization.

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Fig. 1

Spine MRI shows diffuse contrast enhancement of prevertebral soft tissue and endplate at L5-S1 (arrow).

Fig. 2

Septic emboli identified according to imaging modalities (arrow). (A) Contrast-enhanced abdominal CT shows wedge shaped low attenuated lesion at spleen. (B) Aggravated state of spleen after 8 weeks. (C) Brain MRI shows acute ischemic infarct in both occipital lobe. (D) CT angiography of femoral artery shows focal segmental occlusion at distal portion of right popliteal artery.

Fig. 3

Vegetation on the posterior leaflet of mitral valve (arrow). (A) Transthoracic echocardiographic finding. (B) Transesophageal echocardiographic finding after 4 weeks.

Table 1

Laboratory findings, events and antibiotics administered during hospitalization

Table 1

WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; H, isoniazid; R, rifampin; E, ethambutol; Z, pyrazinamide