Campylobacter jejuni-Associated Lumbar Vertebral Osteomyelitis with Cauda Equina Syndrome in the Absence of Gastrointes Symptoms: A Rare Case Report.

BACKGROUND: Campylobacter jejuni (C. jejuni) is a common cause of self-limiting gastroenteritis but rarely causes extraintestinal infections. Vertebral osteomyelitis due to this pathogen is exceptionally uncommon, and cases presenting without gastrointestinal symptoms are even rarer. To our knowledge, no previous case has described lumbar osteomyelitis with a spinal extradural abscess leading to cauda equina syndrome in the absence of enteric symptoms. Diagnosing and managing this infection remains clinically challenging. CASE PRESENTATION: A 65-year-old man presented with a two-month history of intermittent low back pain, bilateral lower limb numbness and pain, urinary frequency, and constipation. He had one episode of fever before admission but no gastrointestinal symptoms. Magnetic resonance imaging (MRI) showed lumbar (L4/5) osteomyelitis with an epidural abscess compressing the cauda equina. The patient underwent L4/5 partial laminectomy and debridement of the spinal canal abscess. Conventional cultures of preoperative blood and intraoperative specimens were negative. Metagenomic next-generation sequencing (mNGS) of both blood and surgical samples identified C. jejuni as the causative pathogen. Antibiotic susceptibility testing was not available. The patient initially received empirical antibiotics but developed recurrent fever. Treatment was switched to intravenous meropenem and levofloxacin, followed by oral levofloxacin for six weeks, completing a nine-week course. At two-year follow-up, MRI confirmed complete resolution of the infection and the patient made a full recovery. CONCLUSION: C. jejuni should be considered in spinal infections even without gastrointestinal symptoms. mNGS is useful when cultures are negative. For cases failing initial antibiotics, meropenem plus levofloxacin may be an option, though further data are needed.