Is Shigella an under-recognized pathogen? A case of pyogenic cervical spondylitis caused by Escherichia coli and Shigella flexneri infection

Shigella typically causes gastrointestinal infections, and extra -intestinal manifestations are rare. We report the first known case of pyogenic cervical spondylitis co -infected with Escherichia coli and Shigella flexneri, highlighting the diagnostic challenges and clinical implications. A 53 -year -old woman presented with neck pain for one month. MRI revealed C6 and C7 vertebrae abscesses. The patient underwent anterior cervical debridement and bone -graft fusion. Intraoperative pus culture grew Escherichia coli, while metagenomic next -generation sequencing detected both Escherichia coli and Shigella species. Intravenous imipenem 500 mg every 6 h was administered, leading to full wound healing at a 6 -month follow-up. This case emphasizes the importance of considering Shigella infection in the differential diagnosis of pyogenic spondylitis and demonstrates the utility of a multi -pronged diagnostic approach.