Enterococcus hirae Bacteremia Complicated by Septic Spondylitis and Acute Pyelonephritis: A Case Report

<i>Enterococcus hirae</i>, a rare human pathogen, has limited clinical data. This case report presents a case of sepsis, pyelonephritis, and septic spondylitis treated successfully with ampicillin. An 82-year-old woman was hospitalized for acute pyelonephritis and sepsis, presenting with fever and abdominal pain. After admission, her back pain appeared, and magnetic resonance imaging revealed septic spondylitis of the lumbar spine. Blood and urine cultures obtained at admission revealed the presence of <i>E. hirae</i>. After six weeks of ampicillin treatment, her symptoms resolved, and she was transferred to a rehabilitation hospital. Retrospectively, a computed tomography scan on admission revealed signs of septic spondylitis, indicating that the patient may have had spondylitis before developing pyelonephritis. <i>E. hirae</i>, a rare cause of infection in various organs, responded well to ampicillin. Despite its rarity, spondylitis should be considered in the elderly with low back pain and pyelonephritis for a complete differential diagnosis.