Research Day

Title

Vancomycin Resistant Enterococcal Endocarditis Presenting as Spondylodiskitis

Document Type

Abstract

Date

2017

Abstract

Introduction: Enterococcal endocarditis generally manifests as classical subacute infection and when metastatic events occur, the embolic events are almost always bland in nature rather than causing metastatic infection. We present a patient with vancomycin-resistant Enterococcus faecalis (VRE) aortic valve endocarditis which presented with lumbar spondylodiskitis, a very unusual manifestation of enterococcal endocarditis. Case Report: A 87 year old man with diabetes and a recent cerebrovascular event was evaluated for increasing lumbar spine pain without fever, chills or other constitutional symptoms. An outpatient MRI revealed fluid in the L2-L3 disk space with enhancement of the L2 and L3 vertebrae and bilateral adjacent psoas muscle. An Interventional Radiology-facilitated aspirate showed many PMNs on Gram stain and culture of the aspirate as well as 4 blood cultures revealed vancomycin-resistant E. faecalis. Retrospectively, the patient had had several urine cultures in the past 2 months which also revealed the same organism. He gave a history of IgE-mediated hypersensitivity to penicillin. Because of the unusual cause of the diskitis and multiple positive blood cultures, a trans-esophageal echocardiogram was performed which revealed a vegetation on the right coronary cusp of the patient's aortic valve. A diagnosis of VRE aortic valve endocarditis was made associated with secondary lumbar spondylodiskitis. He was begun on intravenous daptomycin and the blood cultures became negative. A review of the literature found only several cases of this scenario previously reported and none were linked to VRE as the etiology. Conclusion: Extravalvular secondary infections associated with enterococcal endocarditis as in this case are quite rare. This case is the first known of endocarditis with secondary spondylodiskitis caused by VRE.

This document is currently not available here.

Share

COinS