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Spondylodiscitis caused by Citrobacter koseri: a case report.

Olfa Jomaa1, Mouna Brahem2, Rebeh Bougossa3

  • 1Rheumatology Department, Taher Sfar University Hospital, Mahdia, Tunisia. olfajomaa2@gmail.com.

Journal of Medical Case Reports
|June 4, 2026
PubMed
Summary

Citrobacter koseri, a rare cause of spondylodiscitis, can affect immunocompetent adults. This case highlights successful diagnosis and treatment of community-acquired Citrobacter koseri spinal infection with targeted antibiotics.

Keywords:
Citrobacter koseriCase reportCommunity-acquired infectionEnterobacteralesMagnetic resonance imagingSpondylodiscitisVertebral osteomyelitis

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Spinal Infections

Background:

  • Citrobacter species are gram-negative bacilli rarely causing severe infections in immunocompetent adults.
  • Spondylodiscitis caused by Citrobacter koseri is exceptionally rare, with fewer than 15 reported cases.
  • This report details a community-acquired case to inform diagnostic and therapeutic approaches.

Purpose of the Study:

  • To report a rare case of community-acquired Citrobacter koseri spondylodiscitis.
  • To highlight diagnostic challenges and successful management strategies for this unusual infection.

Main Methods:

  • A 77-year-old woman presented with back pain and fever, elevated inflammatory markers.
  • Spinal MRI revealed T9-T10 spondylodiscitis with epiduritis and phlegmon.
  • Citrobacter koseri was isolated from blood cultures and CT-guided disco-vertebral biopsy.

Main Results:

  • The patient received a 3-week intravenous antibiotic regimen (ceftazidime, ciprofloxacin) followed by 3 months of oral antibiotics (ciprofloxacin, trimethoprim-sulfamethoxazole).
  • The patient achieved complete clinical and biological recovery at 3-month follow-up.
  • No neurological deficits were observed.

Conclusions:

  • Citrobacter koseri can cause spontaneous bacterial spondylodiscitis in community-dwelling elderly individuals without apparent urinary or biliary infection.
  • Definitive microbiological diagnosis (biopsy or blood culture) is crucial for targeted antibiotic therapy.
  • Prolonged fluoroquinolone-based conservative management can yield excellent outcomes in non-neurological deficit cases.