Polymicrobial spontaneous pyogenic spondylodiscitis: A very rare entity!

Spontaneous pyogenic spondylodiscitis (SPS) is an uncommon disease. The most common causative organism of SPS is Staphylococcus aureus, followed by Gram-negative bacilli in 4%–30% of the cases. Polymicrobial SPS is very rare, with only a few cases reported in the literature. We report a case of polymicrobial SPS in a 43-year-old male who was recently diagnosed with autoimmune hepatitis with cirrhosis of the liver and presented with a 1-month history of progressive low backache with radiation to both the legs. Initially, he was managed as a case of Pott's spine with antitubercular therapy on the basis of immunocompromised status with positive ascitic fluid Mycobacterium tuberculosis polymerase chain reaction. However, due to lack of clinical and radiological response after 6 weeks, he underwent computed tomography-guided biopsy of the affected region. The culture from the biopsy specimen yielded Klebsiella oxytoca and Proteus vulgaris. He was managed with culture-sensitive antimicrobials. To the best of our knowledge, this is the first case of polymicrobial SPS caused by K. oxytoca, P. vulgaris, and M. tuberculosis.