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Case Reports
. 2024 Dec 10;16(12):e75501.
doi: 10.7759/cureus.75501. eCollection 2024 Dec.

Enterococcus hirae Bacteremia Complicated by Septic Spondylitis and Acute Pyelonephritis: A Case Report

Tetsufumi Nishi  1 , Yoshihiro Aoki  1   2 , Kensuke Takahashi  1   2 , Shuhei Yamano  1   2 , Koichi Hayakawa  1   2
Affiliations
Case Reports

Enterococcus hirae Bacteremia Complicated by Septic Spondylitis and Acute Pyelonephritis: A Case Report

Tetsufumi Nishi et al. Cureus. .

Abstract

Enterococcus hirae, a rare human pathogen, has limited clinical data. This case report presents a case of sepsis, pyelonephritis, and septic spondylitis treated successfully with ampicillin. An 82-year-old woman was hospitalized for acute pyelonephritis and sepsis, presenting with fever and abdominal pain. After admission, her back pain appeared, and magnetic resonance imaging revealed septic spondylitis of the lumbar spine. Blood and urine cultures obtained at admission revealed the presence of E. hirae. After six weeks of ampicillin treatment, her symptoms resolved, and she was transferred to a rehabilitation hospital. Retrospectively, a computed tomography scan on admission revealed signs of septic spondylitis, indicating that the patient may have had spondylitis before developing pyelonephritis. E. hirae, a rare cause of infection in various organs, responded well to ampicillin. Despite its rarity, spondylitis should be considered in the elderly with low back pain and pyelonephritis for a complete differential diagnosis.

Keywords: acute pyelonephritis; bacteremia; enterococcus hirae; sepsis; septic spondylitis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The renal computed tomography upon admission
(A) Axial CT scan showing bilateral renal pelvic dilation, thickened renal pelvic walls, and inflammatory changes in perirenal fat appearing as cord-like opacities (arrows). The contrast was adjusted for better visualization. (B) Coronal CT scan confirming the bilateral nature of these findings, with evident renal pelvic wall thickening and surrounding inflammatory stranding in the perirenal fat tissue (arrows). The contrast was adjusted for better visualization.
Figure 2
Figure 2. The magnetic resonance imaging and the computed tomography of the lumbar spine
(A) Sagittal view of the magnetic resonance imaging of the lumbar spine on the third day of hospitalization. The short tau inversion recovery (STIR) sequence revealed high signal intensity areas near L4/5 (arrowheads), in addition to preexisting spinal canal stenosis. The contrast was adjusted for better visualization. (B) Axial view of the computed tomography of the lumbar spine on admission. Mild opacity in the fatty tissue around the L4-5 vertebral body was observed (arrows).
See this image and copyright information in PMC

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