Haematogenous bacterial spondylodiscitis due to infection with a well-treatable but easily overlooked and often underdiagnosed pathogen.
An argument against short pedicle screw instrumentation, when urgent surgical therapy of the infected spine is required, in patients with PD and poor general condition.
Especially in cases where a bacterial infection is suspected clinically and by imaging, the detection of germs must be forced by all means in order to be able to treat the patients well.
Introduction and importance: Infectious hematogenous spondylodiscitis (HS) requires urgent treatment. In some cases, the germ detection of very slow growing bacteria can be challenging and a life threatening HS can easily be overlooked.
Presentation of case: A Parkinson's patient presented with slowly increasing immobilising back pain for three months and a deterioration of his general condition. A lumbar spondylodiscitis (L1/2) was diagnosed. We indicated surgical exploration with debridement and dorsal instrumented stabilization (L1-2). On the fifth postoperative day, the patient complained again of severe back pain, caused by implant dislocation. We extended the instrumentation in a revision procedure (Th12-L4). After 5 days of incubation, a pan sensitive Actinotignum schaalii could be detected microbiologically. The patient was discharged free of infection within 14 days after surgery with appropriate oral antibiotic therapy.
Clinical discussion: Actinotignum schaalii is difficult to detect but can be successfully treated. Actinotignum species rarely grow under normal urine culture conditions. In chronic inflammation, as a cause of gradual weight loss, anemia and back pain, Actinotignum schaalii should be considered as a causative agent in the ageing population. In cases of severe HS and comorbidities, a definitive surgical solution is required.
Conclusion: A HS caused by Actinotignum schaalii is rare. Particularly in cases where a bacterial infection is suspected, prolonged incubation under appropriate conditions is essential. Surgical debridement and prolonged antibiotic treatment are substantial to cure the patient.
Keywords: Actinobaculum schaalii; Actinotignum schaalii; Back pain; Case report; Immobilising pain; Parkinson's disease; Spondylodiscitis.