Early Gastric Cancer Removed Endoscopically Followed by a Spinal Infection

What happened, in summary

A man in his 80s presented with black stools and anemia, with hemoglobin at 8.0 g/dL. Endoscopy found a bleeding 30 mm lesion along the lesser curvature of the stomach. Biopsy and imaging supported stage IA early gastric cancer, classified as cT1aN0M0. Because he had recently undergone aortic valve replacement and was taking aspirin and warfarin, endoscopic treatment was performed with heparin bridging. Repeated hemostasis was needed during the procedure, but endoscopic submucosal dissection achieved complete removal without perforation. Pathology showed intramucosal, well-differentiated adenocarcinoma with negative margins.

Three days later, he developed fever of 38.7°C and severe lower-back pain. Blood cultures grew a Streptococcus species, and MRI confirmed pyogenic spondylitis with concern for an epidural abscess. He first received piperacillin and tazobactam, followed by ceftriaxone and then oral cefcapene pivoxil. Back pain and inflammatory markers improved gradually, and antibiotics were stopped after 12 weeks.

At the end of treatment, his pain had resolved and inflammatory markers had normalized. Endoscopy showed a healed scar at the gastric resection site without a new lesion. No spinal-infection relapse was seen during 6 months of follow-up.