Skipped vertebral spontaneous spondylodiscitis caused by Granulicatella adiacens: Case report and a systematic literature review

Abstract

Background: Granulicatella adiacens is a nutritional variant of streptococcus (NVS), which has been rarely reported as an etiologic agent in spondylodiscitis (SD).

Material and methods: We report a case of a 51-year-old male with from chronic low-back pain associated with right sciatica and ipsilateral monoparesis. Spinal MRI showed radiological signs on L1-L2 and L5-S1 discs consistent with SD. We also performed a systematic review of the pertinent literature in order to retrieve all the key information regarding microbiological and clinical features.

Results: Including our patients, seven cases with a mean age 56 ± 10.2 years were reported in English literature. Six patients were conservatively managed with antibiotic therapy (66%), whereas three with surgery in combination with antibiotics (33%). An endocarditis was associated in three cases, and a pacemaker infection in one. All patients received targeted antibiotic therapy resulting in a quick improvement of clinical symptoms with favorable outcome. Our case is the only with a skip spontaneous SD, which needed a surgical decompression due to the associated neurological symptoms.

Conclusions: This incidence of SD sustained by Granulicatella adiances could be underestimated due to their particular microbiological conditions requested for their cultures. However, this infection should be suspected in cases of culture-negative SD, especially when associated with endocarditis.

Keywords: CRP, C-Reactive Protein; Granulicatella adiacens; NVS, nutritional variant of Streptococcus; SD, Spondylodiscitis; Spine infection; Spondylodiscitis; Streptococci; VAS, visual analogue scale; VO, vertebral osteomyelitis; Vertebral osteomyelitis.

Fig. 1

Indexes trend. a: Graphical representation of the CRP values expressed in mg/L; b: Graphical representation of the patient's body temperature expressed in degrees Celsius, day 5 is the day the patient came to the hospital; c: Graphical representation of the values of VAS back and VAS leg.

Fig. 2

Radiological findings. a,c: Sagittal cuts of lumbosacral MRI in T2-weighted sequence that show the presence of a hyper-intensity signal at the L5-S1 and L1-L2 disks. b,c: sagittal cuts of STIR sequences of MRI that highlight signal intensities at the level of the affected disks. At both levels, it is possible to observe the presence of material in the anterior epidural space. At L5-S1 level in the presacral space.

Fig. 3

Search strategy.

Fig. 4

Radiological follow-up. The images collected 1 year after the surgical procedure did not show signs of segmental deformity (a–b) or stenosis (c–d) at the involved segments.