Pneumorrhachis Secondary to Klebsiella pneumoniae Gas-Forming Paraspinal Abscess: A Case report and Review of Literature.

Pneumorrhachis is a rare entity, where air pockets are found in the spinal canal and the etiology can be categorized into traumatic and non-traumatic, the latter further categorized into spontaneous, iatrogenic, and associated with infections. Infective causes are often associated with gas-forming organisms and are associated with significant morbidity and mortality. Often the diagnosis is not suspected until imaging is done. We report the case of a 57-year-old man who presented with fever, backache, lower leg weakness, and dysuria. A computed tomography scan for evaluation of intra-abdominal sepsis incidentally showed pneumorrhachis affecting the thoracic and lumbar levels, gas-forming paraspinal abscess, prostate abscess, liver cirrhosis, and sigmoid colon carcinoma. Blood culture isolated Klebsiella pneumoniae. The patient recovered after six weeks of intravenous antibiotics followed later by sigmoid colectomy and chemotherapy. A literature review identified 63 cases of pneumorrhachis associated with infections and can be categorized into infections with spontaneous pneumorrhachis (predominantly respiratory tract infections), infections with pneumorrhachis (predominantly with emphysematous infections), and iatrogenic with infections and pneumorrhachis (predominantly postspinal interventions). Infections with pneumorrhachis occurred in older age groups and were associated with higher mortality compared to the other two categories.

A fatal case of Ortner's syndrome and dysphagia aortica secondary to rapidly expanding mycotic thoracic aortic aneurysm in a chronic kidney disease patient.

Ortner's syndrome or cardiovocal syndrome is a rare condition and refers to the association between cardiovascular conditions, usually cardiac enlargement from mitral stenosis, and recurrent laryngeal nerve palsy. We reported an interesting case of a patient with end-stage renal disease on regular dialysis who developed both Ortner's syndrome and dysphagia aortica as a result of an aortic arch aneurysm. The aneurysm underwent a rapid increase in size, likely as a result of Staphylococcus aureus infection (mycotic aneurysm) from an internal jugular dialysis catheter. This case highlighted the importance of cardiovascular conditions as rarer causes of dysphonia and dysphagia, particularly with the existence of an extrinsic infective source.