2008 Volume 56 Issue 2 Pages 79-86
We report a case of infective endocarditis (IE) which initially manifested as lumbar spondylodiscitis. A 75-year-old woman was admitted to our hospital because of a 3-week fever, lumbago and dyspnea. Chest radiography on admission showed cardiomegaly with mild pulmonary congestion. Blood examination revealed leukocytosis with marked neutrophilia. Differential diagnosis at this time included infection course, malignancy, collagen vascular disease and hematologic disorders. After 2 sets of adequate venous blood culture, empiric therapy with administration of antibiotics and intravenous steroid was started. Magnetic resonance imaging demonstrated high intensity areas in the L5 vertebra and L5/S1 intervertebral disc which suggested inflammatory changes in the spine. Diagnostic strategy including surgical intervention to the spinal lesion was decided at this time, but a diastolic cardiac murmur was noticed by a round physician. Transthoracic echocardiography was performed, which revealed a mobile flail mass on the base of the intra-ventricular septum projecting into the left ventricular outflow tract. Moderate aortic regurgitation was also observed. About one month after onset of the illness, the patient was diagnosed with IE. The patient was successfully treated with a combination of antibiotics. Endocarditis should be considered in a patient with persisting fever and low back pain associated with spondylodiscitis.
