A Rare Multilevel Spinal Epidural Abscess With Streptococcus agalactiae in an Adult With Uncontrolled Diabetes: A Case Report

Spinal epidural abscess (SEA) is a rare, life-threatening infection that typically presents with fever, back pain, and neurologic deficits. Although most commonly caused by Staphylococcus aureus, this case reviews a rare occurrence of a multilevel SEA caused by Streptococcus agalactiae in a 62-year-old female with uncontrolled type II diabetes mellitus. The patient initially presented with lower back pain and was subsequently diagnosed with a SEA complicated by hyperglycemia. A prompt diagnosis with magnetic resonance imaging (MRI) revealed extensive abscess formation, leading to emergent neurosurgical intervention. Streptococcus agalactiae was identified as the causative organism through culture. The report emphasizes the challenges of early detection of SEA and highlights the importance of considering unusual pathogens in high-risk patients. Timely management is crucial to prevent permanent neurologic deficits and to achieve favorable outcomes.

Tophaceous gout of the cervical and thoracic spine with concomitant epidural infection

Tophaceous gout of the spine is an underappreciated source of back pain in patients with or without neurological decline. It has been reported to occur in the cervical, thoracic and lumbar spine. Rarely, does it occur at more than one region of the spine. Advanced imaging with magnetic resonance imaging and computed tomography are usually not helpful in differentiating between infection, malignancy and gout. Clinician should have a high suspicion of spinal gout in patients with history of gout who presents with renal insufficiency, presence of peripheral tophi on exam, with elevated serum uric acid and creatinine levels, erythrocyte sedimentation rate and C-reactive protein. Here we present a case of a 23-year-old male with history of gout and chronic renal disease with progressive weakness in his lower extremities with new urinary incontinence who was found to have spinal gout with epidural infection of both the cervical and thoracic spine. Our patient was successfully managed with surgical decompression followed by medical treatment with antibiotics and steroids.

Pan-spinal infection: a case series and review of the literature

BACKGROUND

Panspinal infection usually presents with fever, back pain, neurological deficit, and in advanced cases multi-organ failure and septic shock. The choice of treatment for panspinal infection is challenging because these patients are usually medically unstable with severe neurological compromise. The objective of this study is to review management and long term outcomes for patients with panspinal infection.

METHODS

A retrospective review of patients with panspinal infection treated in our center over a 5-year period [Jan 2010-Dec 2014] and a review of the current published literatures was undertaken.

RESULTS

We identified 4 patients with panspinal infection. One case was managed medically due to high perioperative risk, whilst the other three were managed surgically whilst on antibiotic therapy. All 3 cases managed surgically improved neurologically and infection subsided, whereas the patient managed medically did not change neurologically and infection subsided.

CONCLUSIONS

Patients with panspinal infection should be treated surgically unless the medical risk of surgery or anaesthesia is prohibitive.