Infective endocarditis and spondylodiscitis – a duo to remember

Introduction: Infective endocarditis is a severe disea-se, associated with poor prognosis and high mortality. The complications include cerebral, splenic, renal and musculoskeletal embolization, spondylodiscitis being one of them and having a prevalence of 1.8-15%.

Methods: In this context we report the case of a 68 years old patient, without known medical history, who presented for low back pain, associated with dyspnea on moderate exertion, symptoms that started 4 weeks before presentation, with no amelioration to sympto-matic medication. During hospitalization, the patient had fever 38 degree with chills, profuse sweating and asthenia. Clinically, BP=120/80 mmHg, HR=90/min and a systolic murmur was found in the mitral area, with radiation to axilla. Biologically, was found an in-flammatory syndrome and an iron deficiency anemia. Transthoracic and transesophageal echocardiography showed a PML vegetation and a mitral regurgitation grade III. Chest and lumbar x ray were normal. We initiated an empiric treatment with Vancomycin 1gX2/ day and Gentamicin 160mg/day.

Results: T he blood cultures highlighted the presence of Streptococcus mitis, sensible to Vancomycin, whi-ch was continued 1gx2/day, 4 weeks. Considering the persistence of the low back pain, a dorso-lumbar CT was performed, that detected suggestive signs of a disc inflammatory process. During the treatment, the clini-cal and paraclinical evolution was favorable with the regression of the inflammatory syndrome.

Conclusions: Spondylodiscitis is a redoubtable and rare complication of infective endocarditis, it’s mani-festations being able to dominate the clinical appearan-ce of the patient and leading to a difficult differential diagnosis. This association requires a prolongation of the antibiotic treatment, until the resolution of the ima-gistic signs of disc inflammation.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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