Isolated Septic Discitis Associated with Streptococcus bovis Bacteremia Deng-Ho Yang, MD, Mu-Hsin Chang, PhD, and Wei-Chou Chang, MD Abstract: Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of healthy people; it is also associated with colon cancer and infective endocarditis. We report on a 79-year- old male who initially presented with acute-onset lower back pain. Streptococcus bovis was detected in repeated blood cultures, and magnetic resonance imaging of the lumbar spine revealed septic discitis of the L2YL3 intervertebral disc. Excision and debridement of the intervertebral disc was performed and a tissue culture tested positive for S. bovis. Repeat echocardiography and colonoscopy showed no signs of vegetation or tumor lesions, respectively. We diagnosed the patient with isolated septic discitis caused by S. bovis- induced bacteremia. The patient was discharged after six weeks of antibiotic therapy. Key Words: diffuse idiopathic skeletal hyperostosis, discitis, infec- tive endocarditis, Streptococcus bovis, tumor S treptococcus bovis is a Gram-positive coccus associated with infective endocarditis (IE) and colon cancer. Many patients initially diagnosed with S. bovis bacteremia develop IE or colon cancer during the disease course. S. bovis-induced IE can affect aortic or mitral valvular regurgitation, which can progress to heart failure. IE may present with septic discitis in the initial stages, but isolated septic discitis induced by per- sistent S. bovis bacteremia is uncommon. We describe the case of a patient with isolated septic discitis due to S. bovis without a cardiac or colon lesion. Radiography of lumbar spine revealed diffuse idiopathic skeletal hyperostosis (DISH). The coexistence of septic discitis and DISH has been rarely reported. 1,2 Key Points & Aggressive evaluation with echocardiography and colonos- copy is recommended for patients with S. bovis infection. & Infective endocarditis and colon cancer may present with septic discitis in the initial stages. However, isolated septic discitis induced by persistent S. bovis bacteremia can be found clinically. & Antibiotic therapy has been considered necessary for the treatment of septic discitis caused by S. bovis. However, adequate debridement may be useful to treat refractory cases of isolated septic discitis. Case Report A 79-year-old man was hospitalized for acute-onset lower back pain, general weakness, and subfebrile tempera- tures that had persisted for one week. The pain was so severe that he was confined to bed. The patient had a history of benign prostatic hypertension for which he was under regular medi- cation. He had no history of trauma, back or dental surgery, recent urinary tract infection, or recent use of antimicrobial agents. On admission, his blood pressure was 121/73 mm Hg, and his body temperature was 38-C. His heart sounds were normal with no murmur; the lungs were clear to auscultation. The abdomen was soft without palpable masses or tenderness; the liver and spleen were not palpable. Prominent tenderness was noted over the lumbar region. He had normal muscle tone and normal sensibility and muscle strength over both the lower limbs. A complete blood count revealed 20,600 leukocytes/mm 3 (normal range: 4000Y10,000 leukocytes/mm 3 ) and 173,000 platelets/mm 3 (normal range: 150,000Y450,000 platelets/mm 3 ), with no anemia. The C-reactive protein (CRP) level was 7.35 mg/dL (normal value, G0.8 mg/dL) and the erythro- cyte sedimentation rate (ESR), 37 mm/hour (normal value: G15 mm/hour). Urine analysis and culture yielded negative results. One month before hospitalization, radiography of the lumbar spine revealed DISH through the lumbar spine (Fig. 1A). On admission, lumbar spine radiography revealed a low density lesion over L2YL3 with joint space narrowing. Magnetic resonance imaging (MRI) of the lumbar spine performed (continued next page) Case Report Southern Medical Journal & Volume 104, Number 5, May 2011 375 From the Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Armed-Forces Taichung General Hospital, and Insti- tute of Medicine, Chung Shan Medical University; Division of Cardiol- ogy, Department of Internal Medicine, Armed-Forces Taichung General Hospital; and Department of Radiology, Tri-Service General Hospital, National Defense Medical Center. Reprint requests to Deng-Ho Yang, MD, Division of Rheumatology/ Immunology/Allergy, Armed-Forces Taichung General Hospital, No 348, Sec. 2, Chung Shan Road, Taiping 411, Taichung, Taiwan, Republic of China. Email: deng6263@ms71.hinet.net The authors have no financial disclosures to declare and no conflicts of interest to report. Accepted December 20, 2010. Copyright * 2011 by The Southern Medical Association 0038-4348/0Y2000/104-375 DOI: 10.1097/SMJ.0b013e3182142e11 Copyright © 2011 The Southern Medical Association. Unauthorized reproduction of this article is prohibited.