A fatal case of pyogenic spondylitis rapidly progressing to epidural abscess caused by a novel ST-type methicillin-susceptible Staphylococcus aureus ST9378

Inoue T, Setoguchi T, Akashi M, Shimono N, Iwao Y, Kutsuno S, Hisatsune J

Pyogenic spondylitis can be life-threatening; however, its diagnosis remains challenging because of the initial presentation of nonspecific symptoms. Given the vulnerability of the infected site, patients are highly at risk for severe complications, such as epidural abscesses or bacterial meningitis, which can considerably worsen the prognosis. Herein, we report a case of lumbar pyogenic spondylitis initially identified through methicillin-susceptible Staphylococcus aureus bacteremia, which subsequently progressed to an epidural abscess. The abscess rapidly ascended to the cervical region, causing bacterial meningitis and ultimately, a fatal outcome. The strain (JARB-OU3818) was positive for the virulence factor genes of the enterotoxin gene cluster (seg, sei, sem, sen, and seo) but negative for the Panton-Valentine leucocidin (PVL) and toxic shock syndrome toxin-1 (TSST-1) coding genes. Additionally, JARB-OU3818 was ST9378 belonging to the clonal complex 45 lineage. Clinicians should recognize that pyogenic spondylitis may follow an aggressively progressive clinical course, as demonstrated by this case.

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