Escherichia coli Spondylodiscitis: A Case Report and Literature Review

Spondylodiscitis is an infectious inflammatory disease with the involvement of an intervertebral disk and adjacent vertebral bodies. Hematogenic spreading of microorganisms from an infectious site is the most common pathophysiologic cause of vertebral osteomyelitis. In this report, a case of Escherichia coli spondylodiscitis was described and a review of literature was also performed on cases with E. coli spondylodiscitis.

A 68-year-old woman referred to our hospital with a 2-month history of intermittent fever, weight loss, and low back pain. On physical examination, we found obvious bulging with the dimensions of 4 × 20 cm on about L1 - L4 vertebral area. Lumbosacral MRI revealed the evidence of L2 - L3 spondylodiscitis. She had positive blood and urine cultures with ciprofloxacin-sensitive E. coli and successfully treated without surgery after 8 weeks. Nine articles (including 9 patients) regarding E. coli spondylodiscitis or vertebral osteomyelitis have been published from the 1st of January 1985 to the 10th of August 2019. In addition to these cases, here we report 10th case of E. coli vertebral osteomyelitis. Four patients were female and 6 were male. The mean age was 52 years with a range of 12 - 69. Seven cases had a history of fever, and overall, fever and pain at the site of vertebral involvement were the most common symptoms.

In our reported patient, returning to the patient’s medical history and finding a previous urinary tract infection and E. coli bacteremia was crucial in helping to diagnose and treat the patient. In our review, 7 patients had positive blood cultures, a finding that emphasizes the diagnostic value of this test. Escherichia coli spondylodiscitis is a relatively rare disease that has usually a source of urinary tract infection and its clinical signs and symptoms are not distinguishable from vertebral osteomyelitis due to other agents and finally, blood culture can be helpful as a diagnostic method.