Differential diagnosis, investigations, and treatment
He was admitted to the hospital and underwent emergency hemodialysis to correct the hyperkalemia, and his serum potassium level decreased to 4.5 mmol/L. On day 2 of admission, he developed a fever (40.1°C), and his right lower back pain worsened. Pelvic magnetic resonance imaging (MRI) revealed findings suggestive of an epidural abscess and spondylitis at the L5/S1 intervertebral disc (Figure 1). Blood culture revealed anaerobic gram-negative cocci. Based on these findings, the patient’s condition was diagnosed as spondylitis and epidural abscess caused by anaerobic bacteria. Antimicrobial therapy was initiated with intravenous ampicillin/sulbactam (3 g 6-hourly). Testing using a VITEK-ANC Card® identified the pathogen as a Veillonella species. and 16S rRNA polymerase chain reaction identified the species as Veillonellaparvula . Based on the susceptibility by the micro liquid dilution method (Table 2), the antimicrobial agent was changed to ampicillin (2 g 6-hourly).