Septic necrosis of the odontoid apophysis and cervical spondylodiscitis from Enterococcus faecalis endocarditis: a first report

Heart Surg Forum. 2008;11(2):E108-9. doi: 10.1532/HSF98.20071151.

Abstract

We describe a 75-year-old male patient who developed a general syndrome, with a fever of 39 degrees C, weight loss, and cervical pain, during the month following a urological procedure. The presence of positive blood cultures for Enterococcus faecalis, aortic vegetations, and severe aortic regurgitation observed with echocardiogram confirmed the diagnosis of infective endocarditis (IE). Magnetic resonance imaging of the spinal cord showed significant erosion and irregularities of the odontoid apophysis, with hyperintensity of bone marrow in T2-weighted images because of edema and inflammation. These findings suggested an infective necrosis of the odontoid apophysis. Despite the common occurrence of rheumatologic manifestations in IE, with prevalence rates of 25% to 44%, spondylodiscitis is rarely observed (5%-13%). The lumbar region is the most commonly involved. We found only one other reported case of cervical spondylodiscitis. The case we describe is the first report of septic necrosis of the odontoid apophysis associated with IE.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cervical Vertebrae / pathology
  • Cervical Vertebrae / surgery
  • Discitis / pathology*
  • Discitis / surgery*
  • Endocarditis, Bacterial / pathology*
  • Endocarditis, Bacterial / surgery*
  • Enterococcus faecalis*
  • Gram-Positive Bacterial Infections / pathology*
  • Gram-Positive Bacterial Infections / surgery*
  • Humans
  • Male
  • Odontoid Process / pathology
  • Odontoid Process / surgery
  • Treatment Outcome