Recurrent pyogenic spinal infection caused by secondary arterioenteric fistula: A case report

•Hematogenous infections most commonly cause pyogenic spinal infections.•Recurrent pyogenic spinal infections secondary to an arterioenteric fistula are rare.•Pyogenic spinal infections can reoccur due to resident bacteria. There are no reports of pyogenic spinal infections secondary to an arterioenteric fistula in the literature. Herein, we report a case of recurrent pyogenic spinal infection caused by vascular graft penetration into the sigmoid colon. A 66-year-old man with a history of diabetes and abdominal aortic aneurysm surgery suffered from low back pain and fever. He visited his previous hospital, where a lumbar magnetic resonance imaging revealed a spinal infection. The patient received conservative therapy with antibiotics and underwent several surgeries. However, there was no improvement in his symptoms. The patient was referred to and hospitalized at our university hospital. Because intestinal bacteria were repeatedly detected in his blood cultures, a colonoscopy was performed, which revealed the exposure of a vascular graft in the sigmoid colon confirmed by contrast-enhanced computed tomography. We diagnosed the patient with recurrent pyogenic spinal infection caused by secondary arterioenteric fistula. He then underwent sigmoidectomy, resection of the infected vascular graft, and femoral–femoral artery bypass grafting. There was improvement in his symptoms after the surgery. Gastrointestinal examinations should be performed early when intestinal resident bacteria are detected in blood cultures in patients with pyogenic spinal infections.