Prevotella denticola Bacteremic Spondylodiscitis and Epidural Abscess Associated With a Periapical Lesion: A Case...

Prevotella denticola is an anaerobic gram-negative rod that commonly inhabits the oral cavity and is associated with periodontal and periapical infections. Vertebral osteomyelitis caused by Prevotella species is uncommon, and reports involving P. denticola are exceedingly rare.  A 65-year-old man presented with progressive low back pain and difficulty walking following multiple falls. Lumbar magnetic resonance imaging demonstrated L2-L3 spondylodiscitis with an epidural abscess. Fluoroscopy-guided disc aspiration and subsequent full-endoscopic spinal surgery with percutaneous endoscopic discectomy and drainage were performed. Both blood cultures and disc aspirate cultures yielded P. denticola. Further investigation by dental specialists revealed a periapical lesion and periodontal disease, suggesting an odontogenic source of bacteremia. The patient was successfully treated with surgical source control and prolonged antimicrobial therapy, resulting in resolution of inflammatory markers and clinical improvement.  This case highlights the importance of considering anaerobic odontogenic pathogens as potential causes of hematogenous vertebral infections. Comprehensive source investigation, including dental evaluation, should be considered when anaerobic organisms are isolated from blood or spinal specimens.