Lytic lesions: looking lethal but leaving room for a simple cure? A case of Veillonella spinal osteomyelitis

Introduction. Diagnosing clinically significant infection caused by Veillonella species can be a challenge. Veillonella species are usually found in polymicrobial processes and are often regarded as a contaminant. Additionally, they are slow to grow in culture and this can lead to a delay in diagnosis or a missed diagnosis. Veillonella species rarely cause serious infections, but have been found to cause bacteraemia and osteomyelitis. Case presentation. A 67-year-old man with a history of treated prostate cancer presented with 2 weeks of progressive lower back pain and weakness. He had no signs or symptoms of active infection. He was found to have multiple lytic lesions in his lumbar spine that were initially suspected to be secondary to metastatic cancer. However, tissue and blood cultures were ultimately consistent with infection by Veillonella species. Conclusion. This case report highlights the fact that uncommon illnesses can often present like common disease processes. Because of the radiological appearance of the patient’s lesions and his lack of infectious symptoms, a diagnosis of metastatic cancer was initially thought to be likely. Relying on the pathology and culture data, and waiting on the initiation of antimicrobials until the diagnosis was accurately established, were important factors in diagnosing and treating this infection. Veillonella species can be true pathogens when found in isolation and associated with bacteraemia. Additionally, they can cause an indolent infection that can lead to osteomyelitis. Failure to accurately diagnose this infection in a timely manner would have led to ongoing debility and diagnostic uncertainty for this patient.