Lumbar Spondylodiscitis Caused by Clostridium perfringens: A Case Report Highlighting Diagnostic Challenges and Conservative Management

This case report describes a 70-year-old male with a history of hepatic cirrhosis and diabetes who was admitted with severe low back pain, fever, and sepsis. Initially, the back pain appeared consistent with a muscle strain. However, the persistence of symptoms, ongoing fever, and the patient's underlying conditions raised suspicion for a more serious pathology. Blood cultures identified <i>Clostridium perfringens</i>, and MRI confirmed L4-L5 spondylodiscitis accompanied by an epidural abscess. This rare musculoskeletal infection, known for its high mortality risk, was successfully treated with targeted antibiotic therapy alone, as there were no neurological deficits to warrant surgical intervention. After nine weeks of treatment, a follow-up MRI showed the resolution of the abscess, and the patient made a full clinical recovery. The likely mechanism in this case is bacterial translocation driven by portal hypertension and immune dysregulation associated with liver cirrhosis. This case underscores the importance of investigating serious underlying causes in patients presenting with back pain and red flag symptoms, and it demonstrates that conservative management can be effective in spondylodiscitis without neurological involvement, even when caused by rare and high-risk pathogens such as <i>C. perfringens</i>.