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A 64-Year-Old Man with Low Back Pain Due to Clostridium perfringens Lumbar Discitis

Unknown ethiology

Harshil Bhatt, Sandeep Singh

USA Hospitalist Program, Department of Medicine, Goshen Hospital, Goshen, IN, USA

Am J Case Rep 2021; 22:e928014

DOI: 10.12659/AJCR.928014

Available online: 2020-12-08

Published: 2021-01-22


#928014

BACKGROUND: Lumbar discitis caused by Clostridium perfringens is extremely rare. There have only been 7 published cases of confirmed discitis caused by Clostridium perfringens. We write this report to underscore this unusual relationship by discussing an additional case and providing a review of the previously published cases so clinicians can adequately evaluate and treat patients presenting with discitis.
CASE REPORT: A 64-year-old morbidly obese man presented with an acute onset of worsening back pain and generalized weakness after incurring physical trauma related to falling. Additionally, he also developed fever and chills before the presentation. Based on the clinical presentation and elevated serum levels of inflammatory markers, magnetic resonance imaging was ordered, which showed L5-S1 discitis with extension of infection into the epidural space. Fluoroscopy-guided aspiration of the L5-S1 epidural space facilitated the detection of Clostridium perfringens as the involved pathogen. Based on the antibiotic susceptibility report, the patient was treated with intravenous ampicillin for 8 weeks, after which his symptoms resolved.
CONCLUSIONS: Diagnosis of discitis can be very challenging due to its ambiguous clinical presentation, especially in the elderly population due to the presence of underlying degenerative changes. Even though Clostridium perfringens remains a rare cause of lumbar discitis, it should be considered as a pathogen capable of causing infection of the vertebrae and intervertebral discs, thus allowing clinicians to make necessary diagnostic evaluations to provide appropriate targeted treatment to patients presenting with discitis.

Keywords: Clostridium perfringens, Discitis, intervertebral disc, Spine



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