Spinal Leclercia adecarboxylata infection in an immunocompetent patient: case report

Leclercia adecarboxylata (Family: Enterobacteriaceae) is a gram-negative bacillus that is found in diverse environments but has rarely been isolated from the human microbiota. Notably, no patient with a spinal disc infection caused by L. adecarboxylata has been documented to date.

A 60-year-old male presented with chronic lower back pain and decreased extensor hallucis longus muscle power upon examination. Magnetic resonance imaging of the spine revealed canal stenosis at L3-4 and L4-5, along with migrating L4-5 disc material compressing the left lateral recess and foramina. The patient underwent L4-5 decompression and fixation surgery. Culturing of the excised disc material revealed the presence of lactose-fermenting oxidase-negative L. adecarboxylata. This isolate was found to be resistant to ampicillin; first-, second-, and third-generation cephalosporins; and trimethoprim-sulfamethoxazole. The patient was started on ciprofloxacin 500 mg twice daily for 6 weeks and initially showed favorable improvement. However, he was subsequently lost to follow-up, preventing further long-term evaluation of his clinical condition.

A literature review revealed documentation of 227 cases of L. adecarboxylata infections worldwide, which were reported without a clear pattern but with the highest incidences in Asia. The most common manifestations included bacteremia (22% of patients), soft tissue infections (12.3%), and peritonitis. Notably, 86% of patients recovered, whereas 7% died. This case report and literature review emphasize the importance of accurate identification and treatment, as well as the need for further research to address knowledge gaps on the behavior and management of this pathogen.