Lactococcus lactis and Aspergillus fumigatus co-infection in cirrhotic patients: a case study and literature review

Abstract Background Liver cirrhosis combined with spinal infection is rare and difficult to treat. No cases of spinal infections caused by both Lactobacillus lactis and Aspergillus fumigatus have been documented in cirrhotic patients until now. This study presents the first such case to improve awareness of complex spinal infections in these patients. Case presentation A 66-year-old woman with hepatitis C-related cirrhosis (Child-Pugh class B) developed a catheter-related bloodstream infection and persistent low back pain during hospitalization for severe hepatitis. She was diagnosed with mixed infective spondylitis at L1/2 caused by Lactococcus lactis and Aspergillus fumigatus through imaging, mNGS, and pathological tests. Treatment included antibacterial and antifungal therapy, followed by lumbar debridement with bone graft fusion and internal fixation. The patient showed significant improvement in back pain, normalization of inflammatory markers, and overall clinical recovery. The diagnostic process was complex. Conclusion This case of hepatitis C-related cirrhosis complicated by spondylitis due to a mixed infection of Lactococcus lactis and Aspergillus fumigatus is clinically rare and presents a challenging diagnostic process. The pathogens causing spinal infections in patients with cirrhosis are diverse, and clinical manifestations lack specificity, leading to frequent diagnostic delays. For cirrhotic patients presenting with unexplained back pain, spinal infection should be suspected. Immediate spinal magnetic resonance imaging (MRI) and etiological testing (e.g., metagenomic sequencing) are warranted. Treatment should include individualized, full-course antimicrobial therapy and timely surgical intervention when necessary to improve patient prognosis. Clinical trial number Not applicable.