SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Enterococcus Faecalis Lumbar Osteomyelitis With Negative Mri and Pacemaker-Related Complications.

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This case report describes a 79-year-old man with two weeks of worsening low back pain and difficulty walking, without fever or trauma. His history included multiple chronic illnesses and a pacemaker. Although his MRI did not show clear evidence of osteomyelitis, blood cultures from two sets grew Enterococcus faecalis, and a CT-guided lumbar spine biopsy confirmed vertebral osteomyelitis.<br /><br />The case highlights a key diagnostic challenge: MRI can be falsely negative early in spinal infection, especially when findings are subtle. In this patient, inflammatory markers were not markedly elevated, but the white blood cell count was high and clinical suspicion remained strong, prompting further workup.<br /><br />Treatment began with broad-spectrum IV antibiotics, but culture results showed the organism was only susceptible to ampicillin. Despite a reported remote penicillin allergy, the patient successfully underwent a monitored challenge and was switched to ampicillin. Because Enterococcus faecalis can infect implanted devices, concern for pacemaker involvement was raised. A transthoracic echocardiogram showed no vegetations, but before transesophageal echocardiography could be completed, the patient developed ventricular tachycardia and required ICU care. The pacemaker was removed and replaced temporarily during treatment, then a new permanent device was implanted later.<br /><br />The patient improved clinically, with reduced back pain and weakness, and was discharged to rehabilitation in stable condition.<br /><br />The report emphasizes that vertebral osteomyelitis should still be considered in older adults with persistent back pain even when MRI is unrevealing. It also underscores the importance of blood cultures, biopsy, targeted antibiotics, and source control when hardware infection is possible.

Asset Subtitle

Jonathan D. Grube

Meta Tag

Author List Angelica Medina-Pena, Faiza Zafar Sayeed, Jonathan D. Grube, Kathleen Mattingly, Kenneth Hackbarth, Muhammad Nashit, Orlando Perdomo Perez, Rime Ezzeldin, Sai Varun Gadde

Category Clinical Vignettes

Concept Enterococcus faecalis

Concept Vertebral osteomyelitis

Concept Blood Culture

Concept Magnetic Resonance Imaging

Concept Computed tomography-guided biopsy

Distinguished Non-Finalist

Presenter Organization UCF/HCA Ocala Internal Medicine Residency

Presenting Author Jonathan D. Grube

Track Adult

Keywords

vertebral osteomyelitis

Enterococcus faecalis

MRI false negative

low back pain

blood cultures

CT-guided biopsy

ampicillin therapy

pacemaker infection

older adult

spinal infection

Enterococcus faecalis

Vertebral osteomyelitis

Blood Culture

Magnetic Resonance Imaging

Computed tomography-guided biopsy