Differential diagnosis, investigations, and treatment
He was admitted to the hospital and underwent emergency hemodialysis to
correct the hyperkalemia, and his serum potassium level decreased to 4.5
mmol/L. On day 2 of admission, he developed a fever (40.1°C), and his
right lower back pain worsened. Pelvic magnetic resonance imaging (MRI)
revealed findings suggestive of an epidural abscess and spondylitis at
the L5/S1 intervertebral disc (Figure 1). Blood culture revealed
anaerobic gram-negative cocci. Based on these findings, the patient’s
condition was diagnosed as spondylitis and epidural abscess caused by
anaerobic bacteria. Antimicrobial therapy was initiated with intravenous
ampicillin/sulbactam (3 g 6-hourly). Testing using a VITEK-ANC Card®
identified the pathogen as a Veillonella species. and 16S rRNA
polymerase chain reaction identified the species as Veillonellaparvula . Based on the susceptibility by the micro liquid dilution
method (Table 2), the antimicrobial agent was changed to ampicillin (2 g
6-hourly).