The purpose of this report is to address the identification and treatment of rarely found Elizabethkingia meningosepticum infection along with lumbar discitis in a clinical setting. 

Elizabethkingia meningosepticum was first recognized in children with meningitis in the 1950s as an uncategorized bacterium. It survives in colonizing sink basins and taps, chlorinated and municipal water supplies, contaminated medical devices which include syringes, incubators of newborns, mist tents, humidifiers, incubation tubes and respirators.

Case report and literature review

A 64-year-old male with a past medical history of hyperlipidemia, hypertension, diabetes mellitus type 2, hepatitis C infection, presented to the emergency department with lower back pain radiating to both legs which was alleviated by lying down and worsened by walking and movement.  On physical examination, the patient had an elevated temperature and tenderness to palpation around the lumbar vertebrae. There were no neurological deficits present on examination. The patient denied any complaints of saddle anesthesia, urinary or bowel incontinence. Magnetic Resonance Imaging (MRI) of the lumbar spine showed discitis or questionable osteomyelitis around the lumbar vertebrae in the L2-L3 region. Computed tomographic guided biopsy and culture showed the growing gram-negative bacilli; Elizabethkingia meningoseptica, sensitive to fluoroquinolones.  Laboratory findings were significant for only leukocytosis with white blood cell count 11,300 cells per cubic millimeter. Based on sensitivity and resistance patterns and minimum inhibitory concentration (MIC), we treated the patient with Ciprofloxacin 750 mg twice daily for 6 weeks. The patient tolerated the treatment and near resolution of discitis was seen on repeat imaging after 8 weeks. However, the combination treatment with ciprofloxacin and piperacillin/tazobactam would have provided better coverage.

Elizabethkingia meningoseptica is an up-and-coming infection with high risk for complications and mortality. The source of infection is still debatable and further research will be required to evaluate the efficacy of various treatment regimens.