Low back pain after a dental procedure: a case of Streptococcus viridans vertebral osteomyelitis

Abstract

Vertebral osteomyelitis due to Streptococcus viridans following a dental procedure is a rarely reported phenomenon. We discuss the case of a 67-year-old immunocompetent woman who presented with low back pain of 3 weeks duration associated with subjective fever and chills. On admission, the MRI of the lumbar spine showed L5-S1 vertebral osteomyelitis with associated paravertebral and epidural abscesses. Subsequently, detailed history was retaken and the patient reported having had a maxillary tooth extraction followed by a dental implant 2 months prior to the onset of her symptoms. Blood and abscess fluid cultures grew S. viridans Transthoracic echocardiogram showed no evidence of endocarditis. The patient was started on intravenous ceftriaxone but her treatment course was complicated by agranulocytosis requiring a switch to vancomycin. She required a total of 9 weeks of intravenous antibiotics for complete clinical cure.

Figure 1

MRI of the lumbar spine with contrast showing discitis and osteomyelitis at the L5-S1 level. Arrows pointing to paraspinal abscess at the L5-S1 level and rim-enhancing epidural collections at L5, S1 and S2 levels, suggesting probable epidural abscesses with significant narrowing of the spinal cord at these levels.