Discussion
This is a rare case of epidural abscess and spondylitis caused by
V. parvula . Hirai et al.6 reviewed the
literature from 1976 to October 2015 and found 31 cases ofVeillonella infection in humans. Of these cases, five were
musculoskeletal infections caused by V. parvula , including four
spinal infections. There has been only one case of an epidural abscess
caused by V. parvula reported previously.7 To
our knowledge, the current case is the first report of human V.
parvula infection in Japan. The previously reported case of an epidural
abscess caused by V. parvula 7 was in a cancer
patient, and our patient was on hemodialysis; therefore, V.
parvula appears to be an opportunistic pathogen that affects
immunocompromised patients. Previous reports have indicated the
importance of anaerobic culture for identifying this
pathogen;6 in our case, anaerobic culture isolated the
organism, and further investigation revealed the species, suggesting
that anaerobic culture should be considered in patients with signs of an
epidural abscess, especially in immunocompromised patients.
Most Veillonella spinal infections reported to date have been
associated with a subacute course of lower back pain from 1 week to 4
months.1,8,9 Spinal infections may develop serious
complications if the diagnosis is delayed.10 Our case
was diagnosed early using MRI. MRI should be considered in
immunocompromised patients with signs of musculoskeletal infection with
low back pain, such as our case.
In conclusion, this is the first case of epidural abscess and
spondylitis caused by V. parvula reported in Japan.
Musculoskeletal infection caused by Veillonella can lead to
chronic back pain in immunocompromised patients, and early diagnosis
using MRI and anaerobic culture are recommended.