A not too Fragile Bacteroides

We present a rare case of Bacteroides fragilis vertebral osteomyelitis, in a 20-year-old female with no underlying medical conditions. She presented with a three-week history of lower back pain, myalgias, rigors, and night sweats. The patient was febrile and tachycardic, with borderline low blood pressures. Her initial labs showed elevated inflammatory markers with no leukocytosis. MRI of the thoracic and lumbar spine demonstrated T12/L1 discitis/osteomyelitis with phlegmonous changes and concerns for epidural abscess, causing mild to moderate spinal stenosis. Bacteroides fragilis grew in an anaerobic bottle, and a CT-guided biopsy of the T12/L1 lesion grew Bacteroides fragilis. E-test sensitivities revealed sensitivity to metronidazole. The source of bacteremia was thought to be from gut translocation thus concerned about possible co-infection with E. coli from the gastrointestinal tract. Another source of E. coli could have been from her recent E. coli urinary tract infection, whose growth from blood cultures could have been suppressed from recent course of cephalexin. She was treated with six weeks of metronidazole for the Bacteroides fragilis and ceftriaxone for possible co-infection with E. coli, resulting in improvement of her back pain and down-trending inflammatory markers on clinic follow-up after six weeks.