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.