Research Day
STREPTOCOCCUS PNEUMONIAE INFECTION PRESENTING AS CAUDA EQUINA SYNDROME DUE TO EPIDURAL ABSCESS - A CASE REPORT
Document Type
Abstract
Date
2021
Abstract
Case report: 49-year-old female presented to the emergency department with a 3-day history of back pain, cough, urinary retention, and lower extremity weakness. She denied IV drug use On physical exam, she was tachycardic, febrile, and tachypneic. Neurologic examination showed bilateral lower extremity weakness, left worse than right. Reflexes were decreased from T6 level downward. Labs were significant for WBC count of 21.7, hemoglobin of 7.9, and sodium of 123. On straight cath, patient voided 1.2L of urine. Chest MRI showed a large paraspinal mass centered at T6/7 involving vertebral bodies and an epidural abscess causing cord compression at the same level. Neurosurgery was consulted and patient underwent cervicothoracic laminectomies for abscess drainage (C4-T8). Swab culture from surgical site grew pan-sensitive Streptococcus pneumoniae. CT chest performed postoperatively revealed a fluid collection in the left lower lobe at the T7 level suspicious for pulmonary abscess. Patient was treated with 6-week course of ceftriaxone and metronidazole, achieving significant improvement.
Discussion: The infectious diseases team hypothesized that S.pneumo, presumably from a primary pulmonary source, might have caused contiguous osteomyelitis/discitis and epidural abscess on the thoracic spine. Alternatively, patient might have had initial S.pneumo bacteremia from primary lung infection leading to hematogenous osteomyelitis and epidural abscess. Immediate surgical intervention in the setting of cauda equina syndrome and appropriate antibiotic therapy were critical for this patient's recovery. This is a rare case of S.pneumo infection causing epidural abscess and osteomyelitis with favorable clinical outcome even after delayed surgical debridement.