Spondylodiscitis – the first manifestation of infectious endocarditis

Introduction: Infective endocarditis, a relatively rare condition, with an incidence of 1.7-6.2/100,000 cases and up to 15/100,000 cases/year after the age of 50, can sometimes be diagnosed by its complications. Spondy-lodiscitis, as the first manifestation, has a low inciden-ce (up to 2.2%) compared to patients already diagno-sed with infective endocarditis to which screening for spondylodiscitis is done (10-15%).

Methods: We present the case of a 68-year-old patient sent from the Thoracic Surgery Department of the Cardiology Clinic to investigate persistent dyspnea after thoracentesis and the exclusion of pulmonary tubercu-losis. Concurrently, presents intense dorsal pain, with approximately one month onset, which limits patient mobility. The diagnosis of infective endocarditis with methicillin-sensitive Staphylococcus aureus is confir-med according to the two major modified Duke criteria (vegetations on aortic valve at echocardiography and 2 sets of positive haemocultures at 48 hours). In addition, magnetic resonance imaging of the spine highlights the D6 vertebral body destruction with the narrowing of D6-D7 intervertebral space, elements that support the diagnosis of spondylodiscitis.

Results: T he duration of antibiotic treatment with Oxacillin 12 g/day IV and Ciprofloxacin 400 mg/day was established at 6 weeks for endocarditis, with favo-rable clinical progression, with no new signs of embo-lization and with progressive lesssening of dorsal pain. There were no criteria justifying urgent valvular pros-thesis, spinal surgery or prolonged antibiotic treatment for bone lesions.

Conclusions: In conclusion, the association between infective endocarditis and spondylodiscitis should be considered when there are suggestive clinical elements, no matter what the first diagnosis is.

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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