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Case report
Radiation proctitis-related lumbar spondylodiscitis due to Actinomyces odontolyticus: a rare finding
  1. Pedro Madeira Marques1,2,
  2. Maria Marta Quaresma1,2,
  3. Eduardo Haghighi1,2 and
  4. José Augusto Barata1,2
  1. 1Internal Medicine Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Lisbon, Portugal
  2. 2Hospital de Vila Franca de Xira, Vila Franca de Xira, Lisbon, Portugal
  1. Correspondence to Dr Pedro Madeira Marques; pedromarques1{at}campus.ul.pt

Abstract

Lumbar spondylodiscitis due to radiation proctitis-related fistula is a rare finding in the literature. After having isolated Actinomyces odontolyticus, a rare finding in the osteomuscular system, we present one of such cases.

A 75-year-old patient with a history of rectum adenocarcinoma, submitted to surgery and radiotherapy, presented himself in our emergency department with a 3-month history of lumbar pain radiating to both legs. Physical examination was compatible with cauda equina syndrome and subsequent investigation revealed L4–L5 spondylodiscitis. Despite a 6-month antibiotic therapy regimen, the symptoms recurred. Intravertebral disc biopsy revealed A. odontolyticus and directed antibiotic therapy was started. However, the symptoms recurred after a new 6-month antibiotic therapy regimen, this time with rectal purulent drainage. Additional study revealed two rectal fistulae. It was assumed those were caused by radiation proctitis and constituted the primary cause of spondylodiscitis. Laminectomy was performed with a satisfactory clinical response.

  • colon cancer
  • bone and joint infections

https://doi.org/10.1136/bcr-2020-237047

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    Footnotes

    • Contributors PMM: Responsible for the initial diagnosis of spondylodiscitis, articulation with neurosurgeons to perform intravertebral disc biopsy, daily clinical evaluation and antibiotic therapy response. MMQ: Responsible for daily clinical evaluation and monitoring antibiotic therapy response. EH: Responsible for the decisions as to which diagnostic procedures and therapeutic measures were taken and articulating with orthopaedic surgeons to perform laminectomy. JAB: Responsible for all the diagnostic and therapeutic procedures, provided guidance as to which procedures should be performed and at which time, and revised the draft of this paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.