Spinal Infection Due to Enterococcus faecalis as the First Manifestation of Colorectal Cancer

Spinal epidural abscess is a relatively infrequent surgical indication, but it may be neurologically compromising. The most frequent pathogen is Staphylococcus aureus, present in two-thirds of the cases. Enterococcus faecalis is part of the intestinal flora and is uncommon in this condition. Colorectal cancer is reported to be a cause of hematogenic translocation and distant infection. We present a case of an 82-year-old patient admitted for acute low back pain with increased inflammatory markers and negative blood cultures. An MRI revealed an epidural lumbar abscess with adjacent spondylitis. After surgical treatment, E. faecalis was identified, and antibiotics were adjusted accordingly. A colonoscopy revealed colon cancer. This is the first case in the literature of a spinal epidural abscess by E. faecalis as the first manifestation of a newly diagnosed colorectal cancer. When facing a spinal infection caused by atypical intestinal bacteria and no other clear sources, a colonoscopy should be considered.