Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report

An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.

First case of Nocardia nova spinal abscess in an immunocompetent patient

Nocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. Primary Nocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.

Absceso Espinal Epidural secundario a bloqueo terapéutico: presentación de un caso / Epidural spinal abscess secondary to therapeutic blockade: presentation of a case

El Absceso Espinal Epidural es una colección purulenta que se localiza entre la duramadre y el canal raquimedular, siendo una entidad rara, y constituye una situación devastadora, causando una alta morbimortalidad si no se le da un seguimiento adecuado. Se origina por extensión directa (contigüidad, procedimientos invasivos locales) o por diseminación a partir de focos infecciosos a distancia (vía hematógena). Tiene una incidencia de 1 por cada 10 000 pacientes, con mayor afección en la tercera edad (sexta década), sin obviar las demás, incluyendo la infancia, con reportes en la literatura de más de 90 casos; con el advenimiento de drogas que se utilizan por vía endovenosa hay tendencia a aumentar en la población joven, así como, un predominio del sexo masculino. Es una patología de baja incidencia, la fiebre y el dorso lumbalgia son los síntomas más frecuentes, seguido de dolor de distribución radicular asociado a déficit motor y trastornos de esfínter tanto anal como vesical. En ocasiones puede desarrollar un cuadro séptico, llegando al shock séptico. El estudio de elección es la resonancia magnética con gadolinio. Constituye una urgencia tanto neuroquirúrgica como infectológica. En los pacientes con déficit neurológico, la cirugía es el tratamiento de elección, sumado a la antibióticoterapia.

Absceso epidural lumbar post hernia discal traumática: caso clínico / Lumbar epidural abscess secondary to traumatic disk herniation: a case report

We report the case of a 42-year-old male patient presenting with trauma history and lumbar spine axial compression which caused a herniated nucleus pulposus at lumbar level, revealed through MRI. After a four-day evolution period, fever and laboratory alterations indicative of an infectious process appear without signs of neurologic involvement. Hemoculture was positive for Staphylococcus aureus and MRI showed the presence of a lumbar spinal abscess secondary to infected epidural hematoma. The patient was treated with antibiotics, being given ceftriaxone, metronidazol, and gentamicin as an initial theraphy switched subsecuently to cloxaciline and cefazoline, He showed a favourable evolution, completing a six-week period of endovenous treatment plus four weeks receiving oral therapy The patient was discharged in good condition with no neurologic deficit.

Se presenta el caso de un hombre de 42 años con historia de trauma y compresión axial de la columna lumbar que originó una hernia de núcleo pulposo a nivel lumbar, demostrada mediante resonancia magnética. Al cuarto día de evolución aparece fiebre y alteraciones de laboratorio concordantes con infección, sin signos de compromiso neurológico. El hemocultivo resulta positivo para staphylococcus aureus. La resonancia magnética demuestra presencia de absceso espinal lumbar, que impresiona secundario a hematoma epidural infectado. El paciente es tratado médicamente, con antibioticoterapia que incluye inicial mente ceftriaxona/ metronidazol/ gentamicina y posteriormente cloxacilina/cefazotina, con buena evolución, completando 6 semanas por vía endovenosa y 4 vía oral. Su evolución fue favorable, siendo dado de alta en buenas condiciones y sin déficit neurológico.

Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.

Spinal epidural abscess due to Mycobacterium tuberculosis in a patient with AIDS: case report and review of the literature

Spinal epidural abscess (SEA) is a rare infectious disorder that often has delayed diagnosis and is associated with significant morbidity and mortality rates. We present a case of an AIDS patient with a SEA due to Mycobacterium tuberculosis. This type of SEA in AIDS patients is characterized by localized spinal pain and prolonged fever. Magnetic resonance imaging is the method of choice in the diagnostic process. Early diagnosis, followed by specific therapy (surgical decompression combined with antituberculous drugs), is necessary to improve the prognosis of these kinds of patients.

Espondilodiscitis y absceso epidural candidiásico / Candida spondylodiscitis and epidural abscess

Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess

Candida spondylodiscitis associatd with epiduralabscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapyand developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epiduralabscess

Cervical Epidural Abscess Secondary to Aorto-Duodenal Fistula: A Case Report

Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.

Epidural abscess and Staphylococcus aureus endocarditis - a rare association.

Epidural abscess is a relatively uncommon disorder. Although the surgical management is the mainstay of treatment, there are case reports of it being managed conservatively in selected patients. We report a patient who presented with quadreparesis due to epidural abscess and had infective endocarditis due to Staphylococcus aureus septicemia. Both epidural abscess and infective endocarditis were managed conservatively with intravenous antibiotics given for four weeks, with complete recovery of patient.

Abscesso epidural raquiano piogênico / Pyogenic epidural spinal abscess in adolescents

O acometimento bacteriano não tuberculoso do espaço epidural raquiano é raro nas primeiras décadas de vida. Apesar do aparente aumento na incidência constatado nas casuísticas modernas, a descrição dessa entidade patológica em nosso meio permanece esporádica. Os autores apresentam três casos em adolescentes com idade média de 13,6 anos. As peculiaridades da apresentação clínica e do manejo terapêutico ideal são discutidas. Ressaltam que um elevado grau de suspeição clínica deve ser mantido para evitar um retardo no diagnóstico desses pacientes.

The nontuberculous epidural spinal abscess is a rare form of spinal infection in the first decades of life. Despite the recent increase in its incidence, the reports in our Country remains sporadic. Three cases in adolescents ? mean age of 13.6 years ? are reported. The clinical apresentation and the ideal manageent are discussed. A high grade of clinical suspicion is strongly recommended to avoid a diagnostic delay.