Endocarditis has been shown to be a common cause of vertebral osteomyelitis . This combination is potentially fatal and needs to be diagnosed early with an echocardiogram. Suspicion is the key with a complete history taking and physical examination. . In this article we review the literature for the diagnosis and management of spondylodiscitis in relation with endocarditis. We illustrate this review with a case report of delayed diagnosis of endocarditis in two patients with spondylodiscitis. Introduction Spondylodiscitis is a condition that most orthopaedic surgeon will have to deal with. Its diagnosis can be challenging. It is known that the pathogenesis of the disease is mainly haematogenous in origin and various predisposing factors such as cancer, diabetes mellitus, steroids, chronic renal or hepatic disease and poor dental hygiene have all been highlighted 1 . Recently it has been recognised that infectious endocarditis is the cause of spondylodiscitis more frequently than it was believed. A thorough history taking and physical examination are therefore crucial for the diagnosis. It is important to note the presence of a cardiac past medical history (such as valve replacement surgery), to actively look for the presence of a murmur on auscultation of the heart and to proceed with blood cultures in any patient with a suspicion of spondylodiscitis. If a disc infection is confirmed by a biopsy an echocardiogram should be systematically performed if there is some cardiac history or if the biopsy grows streptococcus species in order to exclude endocarditis. In this article we review the literature for the diagnosis and management of spondylodiscitis in relation with endocarditis. We illustrate this review with a case report of delayed diagnosis of endocarditis in two patients with spondylodiscitis. Case Report 1 Mr RW a 59 years old gentleman was admitted with a 5 week history of lower back pain associated with night sweats, a cough and weight loss of 4 kilograms. On examination he was neurologically intact but was significantly tender over L1-2.It was also noted that he had a pan-systolic murmur from congenital mitral valve disease. A plain X-ray was noted to show degenerative changes with disc space narrowing and end plate involvement with sclerosis at L1-2 level (Figure 1).
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