Veillonella spondylodiscitis in a healthy 76-year-old lady

Abstract

Purpose To report a case of Veillonella spondylodiscitis in a healthy 76-year-old lady. Methods A previously healthy 76-year-old lady presented with worsening axial back pain at the thoracolumbar junction, fever and loss of weight. Examination revealed deep tenderness over the thoracolumbar junction with painful and restricted spinal movements. The lower limb motor power, sensation and reflexes were normal. Results Radiographs of the lumbosacral spine showed evidence of spinal instability with lateral translation and loss of disc space at L1-L2. MRI scans revealed fluid intensity within the L1-L2 disc with infective debris elevating the posterior longitudinal ligament and narrowing the spinal canal. Both tissue and blood cultures were positive for the anaerobic organism, Veillonella. A staged anterior-posterior spinal surgery followed by an extended course of antibiotics resulted in the clinical improvement and normalisation of blood parameters. A review of the literature on Veillonella infections is also presented. Conclusion The aim of this report is to bring Veillonella spondylodiscitis to the attention of spinal surgeons and infectious disease specialists and discuss the management options.

Epidural abscess caused by Veillonella parvula: Case report and review of the literature

“…25,26 In the seven reported cases of Veillonella spinal infection, all recovered with 12,15,16 or without surgery. 11,13,14,17 Administration of appropriate antibiotics is also very important.…”

“…16 However, Veillonella spinal infection also can be found in healthy adults. 12,14,17 Because Veillonella species only can use lactic acid for energy generation, they prefer hypoperfusion conditions, in which the intermediate pyruvic acid cannot be oxidatively dissimilated and will be converted into lactic acid. This is the underlying reason why they are often isolated from periodontitis or sinusitis.…”

“…Little has been written about the occurrence of Veillonella in infections, and it is difficult to evaluate the prevalence and clinical importance of Veillonella species, which are rare causes for serious infections such as meningitis, osteomyelitis, prosthetic joint infection, pleuropulmonary infection, endocarditis, and bacteremia. 10,11,12,13,14,15,16,17,18,19,20 We performed a MEDLINE search using the keywords "Veillonella infection", "anaerobic osteomyelitis", "anaerobic epidural abscess", and "anaerobic spine infection" to search for reports/studies on spine infection caused by Veillonella species, and found only seven cases (Table 1). 11,12,13,14,15,16,17 Including the present case, the median age of the patients infected was 57.8 years (range: 27e76 years).…”

Case report: vertebral osteomyelitis secondary to a dental abscess

“…The most common gram-positive species are Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, and Enterococcus species while the most common gramnegative species are E. coli, Pseudomonas aeruginosa, and Proteus mirabilis. 4,5,6,7 However, vertebral osteomyelitis is rarely caused by strictly anaerobic organisms, accounting for only 3-5% of all spondylodiscitis cases [4][5][6].…”

“…Veillonella is an anaerobic gram-negative bacterial species known to be found in the oral cavity, gastrointestinal tract, and female genital tract [4,[7][8][9]. Thirteen species of the genus have been identified, with only six having been isolated in human oral cavities [10].…”