Lumbar spine infection caused by Gardnerella vaginalis: a case report and literature review.

BACKGROUND

Gardnerella vaginalis, which is mainly distributed in the female genitourinary tract, is the main agent causing bacterial vaginosis, as well as a relatively uncommon cause of extragenital infection, and a rare source of joint or spinal infections.

CASE PRESENTATION

We report a 51-year-old female patient with no underlying disease who presented with intermittent low back pain, evident after both being sedentary and prolonged activity. The patient was diagnosed with a pyogenic spinal infection at another hospital and treated with analgesic and cephalosporin anti-infective therapies. The patient then attended our hospital and was initially considered to have a gram-positive bacterial infection; tuberculosis infection could not be excluded. After 3 weeks of empiric anti-infective therapy with vancomycin and linezolid, the patient complained of no improvement in pain and the inflammatory markers had not declined significantly. A clear lumbar spine infection lesion was detected, with evident bone destruction; therefore, we performed surgery for lumbar lesion removal and internal fixation. Lesion specimens were subjected to pathological examination and high-throughput sequencing, which revealed G. vaginalis infection, and the patient received postoperative antibiotic therapy with lincomycin and metronidazole. After 12 weeks of consecutive anti-infective treatment, the pain symptoms of the patient improved. No signs of recurrence were detected at 16 months postoperative follow-up.

CONCLUSIONS

We reported a rare case of isolated G. vaginalis lumbar spine infection. Additionally, we reviewed 13 published cases of joint or spinal infections caused by Gardnerella. G. vaginalis should be considered in cases of joint or spinal infections. Clinical presentation and imaging are insufficient to diagnose spinal infections caused by G. vaginalis, and invasive procedures, such as biopsy, microbial culture, and high-throughput sequencing, are required. Lincosamide or nitroimidazole antibiotic treatment for ≥ 6 weeks is effective in treating bone and joint infections caused by G. vaginalis.