When the Heart and Spine Collide: A Rare Infectious Challenge

Abstract

Right-sided infective endocarditis is an uncommon form of infective endocarditis and represents a particular diagnostic and therapeutic challenge in patients receiving haemodialysis. This case report describes a 60-year-old woman with diabetes and hypertension who had been receiving haemodialysis for one year and presented with dyspnoea, chills, and fever. Transthoracic echocardiography demonstrated a 26 mm × 24 mm hyperechogenic mass in the right atrium, partially protruding through the tricuspid valve and prolapsing into the right ventricle. Blood cultures detected coagulase-negative Staphylococcus, non-albicans Candida, and Candida tropicalis, and right-sided infective endocarditis was diagnosed using the Duke criteria. Treatment was tailored to renal function and included vancomycin, gentamicin, and voriconazole. After two weeks, persistent poorly localised lumbago and back pain prompted lumbar magnetic resonance imaging, which showed infectious spondylodiscitis at L4-L5. Lumbar corset immobilisation was initiated, and rifampicin was subsequently added because the vegetations persisted without reduction in size. After five weeks of treatment, the patient showed clinical improvement, resolution of the inflammatory profile, and a reduction in vegetation size. Persistent lumbago with worsening disc lesions required laminectomy, after which a favourable clinical course was documented. This case highlights the importance of recognising extracardiac infectious complications when new spinal symptoms develop during treatment of infective endocarditis in a patient receiving haemodialysis.