Atypical presentation of thoracic spondylodiscitis caused by Streptococcus mitis
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1Department of Internal Medicine, Scottsdale Healthcare, Shea Hospital, Scottsdale, Arizona, USA.
Abstract:
Spondylodiscitis, which is most commonly caused by Staphylococcus aureus, is an uncommon infection in adults. The diagnosis of spondylodiscitis is often delayed by its vague and non-specific presentations. As part of the normal flora in human mouth and sinuses, Streptococcus mitis is a very rare cause of spondylodiscitis. We report a case of thoracic spondylodiscitis caused by S. mitis in a patient with chronic sinusitis. The patient atypically presented with a sharp chest pain that radiated to the back and the imaging studies were initially negative. He failed outpatient pain management and the diagnosis of spondylodiscitis was confirmed by bone biopsy 6 weeks later. Treatment with antibiotics completely alleviated the pain. Increased awareness and a high index of suspicion are essential for early diagnosis of spondylodiscitis with an atypical presentation.
Insights
Thoracic spondylodiscitis caused by Streptococcus mitis is rare. Early diagnosis requires high suspicion, especially with atypical chest pain and negative initial imaging, as this infection can be delayed.
Area of Science:
- Infectious Diseases
- Orthopedics
- Microbiology
Background:
- Spondylodiscitis is an uncommon adult infection, frequently caused by Staphylococcus aureus.
- Diagnosis is often delayed due to vague and non-specific clinical presentations.
- Streptococcus mitis, a common oral and sinus flora, is a rare pathogen in spondylodiscitis.
Observation:
- A case of thoracic spondylodiscitis caused by Streptococcus mitis in a patient with chronic sinusitis is presented.
- The patient exhibited atypical symptoms of sharp chest pain radiating to the back.
- Initial imaging studies were negative, and outpatient pain management was unsuccessful.
Findings:
- Spondylodiscitis diagnosis was confirmed via bone biopsy six weeks after symptom onset.
- Antibiotic treatment effectively resolved the patient's pain.
- This case highlights Streptococcus mitis as a potential, albeit rare, cause of spondylodiscitis.
Implications:
- Increased awareness and a high index of suspicion are crucial for the early diagnosis of spondylodiscitis.
- Atypical presentations of spondylodiscitis necessitate thorough investigation beyond initial negative findings.
- Understanding rare pathogens like Streptococcus mitis can improve diagnostic accuracy in spinal infections.