Spinal abscess and mitral valve endocarditis secondary to asymptomatic fusobacterium-induced dental abscess

Fusobacterium nucleatum is an anaerobic bacillus of oropharyngeal origin.We describe a case of two manifestations of fusobacterium-induced sepsis originating from an asymptomatic dental root abscess. CASE HISTORYA 63-year-old Caucasian man presented to the accident and emergency department with a 2-week history of night sweats, anorexia, 6 kg weight loss and lumbo-sacral back pain radiating to the right buttock and thigh.In addition, he had been intermittently confused and drowsy over the previous 48 hours.Other than gout and osteoarthritis there was no significant past medical history.On examination, he was apyrexial but tachycardic, with normal cardiac sounds and no peripheral stigmata of infective endocarditis.There was no focal spinal tenderness or nuchal rigidity and neurological examination was normal apart from significantly diminished straight leg raise on the right.Laboratory tests showed raised inflammatory markers (C-reactive protein [CRP] 402 mg/L, normal range [NR]510; erythrocyte sedimentation rate [ESR] 84 mm in first hour), leucocytosis, (total white cell count [WCC] 27.5 with neutrophils 23.1Â10 9 /L) and deranged liver function (alkaline phosphatase 282 IU/L, NR5125; AST 53 IU/L, NR540; LDH 225 IU/L, NR5180).Serial blood cultures, myeloma screen, tumour markers, X-ray of the chest and lumbo-sacral spine, abdominal ultrasound and electrocardiogram were negative or normal.Magnetic resonance imaging of the lumbar spine showed discitis of L4/L5.This disc was subsequently aspirated under computed tomography guidance prior to commencement of empirical antibiotic therapy with intravenous flucloxacillin and oral Fucidin (sodium fusidate).