Pyogenic Spondylitis Due to Erysipelothrix rhusiopathiae Infection: A Case Report

The incidence of pyogenic spondylitis is growing worldwide, but that caused by zoonotic bacteria is not well-reported. Erysipelothrix rhusiopathiae infections of the spine are rare. We report a case of spondylitis caused by E. rhusiopathiae in a patient without a history of livestock industry work. An 82-year-old retired Japanese man experienced vomiting, loss of consciousness, and incontinence during dinner. Subsequently, an ambulance was dispatched, and he was transferred to a local general hospital. Upon admission, brain computed tomography and magnetic resonance imaging revealed no abnormalities, and echocardiography ruled out infective endocarditis. The patient presented with a fever of unknown origin and received piperacillin/tazobactam. Seven days later, a blood culture test identified E. rhusiopathiae, leading to a diagnosis of bacteremia caused by this organism. The treatment was then switched to ampicillin. Despite this, the low back pain appeared and worsened. Lumbar MRI detected spondylitis, necessitating spinal surgery. Following the procedure, inflammation and pain were markedly reduced, and no recurrence was noted after one year and four months. Notably, the patient had no history of animal contact but resided in a home heavily littered with garbage, reportedly with rats present. Therefore, the unsanitary conditions may have been a contributing factor to a rare bacterial infection of the spine.