Spinal Epidural Abscess Unmasking Streptococcus Gallolyticus Endocarditis: A Rare but Treatable Entity

Infective Endocarditis (IE) is a microbial infection of the endocardial surface of the heart, most often involving the cardiac valves, leading to the formation of vegetations composed of organisms and inflammatory debris. While many patients with IE experience joint, muscle and back pain, actual infections at these sites are uncommon. Spinal abscess formation represents an uncommon yet clinically significant complication seen in patients with IE. Among these various spinal locations, involvement of the lumbar region is particularly rare. When it does occur, it typically results from haematogenous spread of infecting microorganisms from the cardiac vegetation to the vertebral or epidural spaces. These abscesses may present with back pain, neurological deficits or signs of systemic infection, making early recognition and treatment crucial to prevent serious outcomes. Although surgical intervention is typically the mainstay of therapy for spinal abscesses, conservative management can still be considered and prove to be effective in selected cases. We present a case of a 52-year-old gentleman with complaints of low back pain over a duration of three months, who, on Magnetic Resonance Imaging (MRI) was diagnosed to have a lumbar epidural abscess caused by Streptococcus gallolyticus endocarditis. He was subsequently treated with an 8-week course of intravenous antibiotics. This case highlights the importance of considering spinal epidural abscess as a potential complication in patients with bacterial endocarditis, thereby underscoring the critical need to include spinal epidural abscess in the differential diagnosis when evaluating patients with bacterial endocarditis who develop new or unexplained spinal symptoms.