Introduction: The primary source of spondylodiscitis cannot always be identified. However, not treating the original focus might preclude successful healing due to further spread of the causative microorganisms. Case report: An 80-year-old woman presented with lumbar spondylodiscitis. She received surgical debridement and stabilization with transforaminal lumbar interbody fusion and tailored antibiotic therapy after isolation of Enterococcus spp. Despite appropriate treatment, the patient's condition continued to worsen. An extensive search for the primary infection source finally revealed a rectal fistula caused by a synthetic mesh that had been inserted 7 years before for abdominal sacrocolpopexy. Only after removal of the fistula and protective ileostomy did the patient's condition improved, allowing successful healing of the spondylodiscitis. After a follow-up period of one year no infection relapse was observed. Conclusion: In cases of spondyodiscitis that are resistant to adequate treatment, a search for infection source must be continued until the focus is found and treated. The presence of uncommon enteric microorganisms causing spondylodiscitis, such as Enterococcus spp., is suggestive of contiguous spread and should therefore be further investigated.
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