Recurrent Cervical Pyogenic Spondylodiscitis Caused by Streptococcus gallolyticus subsp. pasteurianus: A Case Report

Pyogenic spondylodiscitis is a rare infection, with cervical spine involvement occurring in only 3%-10% of the cases. Streptococcus gallolyticus subsp. pasteurianus, a normal gut flora component, is a rare causative agent of spinal infections. Here, we report the case of an 88-year-old man with cervical pyogenic spondylodiscitis caused by this organism, complicated by a clinical relapse following a standard antibiotic course. The patient presented with fever and neck pain. Blood cultures revealed Streptococcus gallolyticus subsp. pasteurianus, and cervical magnetic resonance imaging (MRI) revealed spondylodiscitis at the C4-C6 levels. The patient was treated with a 90-day course of antibiotics (46 days intravenous and 44 days oral), leading to initial clinical and biochemical resolution. However, clinical relapse occurred on day 174, characterized by recurrent neck pain and elevated C-reactive protein levels despite no clear signs of active inflammation on repeat MRI. Extended oral antibiotic therapy was resumed and continued for 9 months, resulting in sustained remission without surgical intervention. To our knowledge, only isolated case reports of spinal infections caused by this subspecies have been published, and no prior case has described clinical recurrence. This case suggests that standard antibiotic durations may be insufficient in selected complex or relapsing spinal infections caused by Streptococcus gallolyticus subsp. pasteurianus and highlights the importance of individualized treatment duration and long-term surveillance.