Lumbar spine spondylitis due to Staphylococcus schleiferi following coronary angioplasty: isolation of the pathogen in peripheral blood cultures

Abstract number: 1134_02_385

Karakolios A., Karagiannidou C., Kallinikidis T., Markou F., Kontos V., Tsinopoulos G.

A 70-year old man presented with acute, severe lower back pain 3 weeks after having been subjected to coronary angioplasty for ischaemic heart disease. He was treated with NSAIDs but not antibiotics without any improvement. CT scan of the lumbar spine showed changes in L5-S1 vertebrae that were consistent with spondylitis. MRI imaging, as well as confirming spondylitis at L5-S1, it also revealed the presence of a left paravertebral abscess. On admission to hospital, low grade fever was documented. Clinical examination of the lower limbs was normal. Staphylococcus schleiferi, sensitive to several antibiotics, was isolated from 3 sets of blood cultures taken from both arms. Initially, Ciprofloxacin 200 mg bd IV was administered for 4 weeks. Despite continuous clinical improvement, MRI imaging 8 weeks after the commencement of antibiotic treatment showed no improvement of the radiological findings. Thus, Levofloxacin 500 mg bd p.o. Rifampicin 300 mg bd p.o. were given for further 16 weeks. At the end of the treatment, the patient was symptom-free, resumed full activity and MRI imaging showed considerable improvement. Multiple blood cultures taken from both arms at different time points can help isolate pathogens causing spondylitis averting thus the need for difficult, interventional sampling of the focus of infection.