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Pneumococcal Vertebral Osteomyelitis after Epidural Injection: A Rare Event

View Article: PubMed Central - PubMed

ABSTRACT

Streptococcus pneumoniae vertebral infections have rarely been reported. Herein, we report a case of pneumococcal vertebral osteomyelitis with paraspinal and epidural abscesses as well as concomitant bacteremia following epidural injection. This will be the second case in the literature reporting pneumococcal vertebral osteomyelitis related to epidural manipulation.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging of the lumbosacral spine with intravenous contrast showing epidural crescent collection posteriorly L1–2 consistent with epidural abscess, enhancement of the vertebral bodies L3–4, and multiple fluid collections extending in the paraspinal musculature from L2 to S1
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Figure 1: Magnetic resonance imaging of the lumbosacral spine with intravenous contrast showing epidural crescent collection posteriorly L1–2 consistent with epidural abscess, enhancement of the vertebral bodies L3–4, and multiple fluid collections extending in the paraspinal musculature from L2 to S1

Mentions: A 62-year-old male with lumbago presented with acutely worsening back pain after receiving an epidural injection 1 month before evaluation. The pain was constant, aggravated by movement, and associated with bilateral lower extremity numbness and weakness. Furthermore, the patient reported a 2-day history of fever (103.2°F maximum), chills, and decreased ambulation. No bowel/bladder dysfunction, saddle anesthesia, or incontinence was noted. Physical examination revealed tachycardia, L3–4 pinpoint tenderness, and reduced lower limb motor strength. Laboratory studies expressed leukocytosis without bandemia and elevated erythrocyte sedimentation rate (94 mm/h) and C-reactive protein (18.989 mg/dL). Chest X-ray was negative for infiltrate. Contrast magnetic resonance imaging of the lumbosacral spine revealed marrow enhancement of L3–4 including facet, multiloculated abscesses involving paraspinal musculature, epidural abscess, and cauda equina impingement [Figure 1]. Septic workup was obtained before empirically starting vancomycin and piperacillin-tazobactam. Computed tomography-guided aspiration of the paraspinal abscesses was completed, followed by surgical evacuation of epidural abscess and laminectomy due to worsening neurologic deficits. Two days later, blood cultures taken on admission and before surgical intervention revealed growth of penicillin-sensitive S. pneumoniae. Extracted purulent materials expressed the presence of many white blood cells on Gram stain but no organisms. After surgical intervention, the patient's pain and neurologic function significantly improved and defervescence with continued antibiotics. He was subsequently deemed stable for discharge. Given the sensitivity profile of the pneumococcus isolated as well as the extent and severity of illness, he was treated with ceftriaxone 2 g twice daily for 6 weeks. Upon completion of antibiotic therapy, repeat magnetic resonance imaging noted resolution of bone marrow signaling changes.


Pneumococcal Vertebral Osteomyelitis after Epidural Injection: A Rare Event
Magnetic resonance imaging of the lumbosacral spine with intravenous contrast showing epidural crescent collection posteriorly L1–2 consistent with epidural abscess, enhancement of the vertebral bodies L3–4, and multiple fluid collections extending in the paraspinal musculature from L2 to S1
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4997796&req=5

Figure 1: Magnetic resonance imaging of the lumbosacral spine with intravenous contrast showing epidural crescent collection posteriorly L1–2 consistent with epidural abscess, enhancement of the vertebral bodies L3–4, and multiple fluid collections extending in the paraspinal musculature from L2 to S1
Mentions: A 62-year-old male with lumbago presented with acutely worsening back pain after receiving an epidural injection 1 month before evaluation. The pain was constant, aggravated by movement, and associated with bilateral lower extremity numbness and weakness. Furthermore, the patient reported a 2-day history of fever (103.2°F maximum), chills, and decreased ambulation. No bowel/bladder dysfunction, saddle anesthesia, or incontinence was noted. Physical examination revealed tachycardia, L3–4 pinpoint tenderness, and reduced lower limb motor strength. Laboratory studies expressed leukocytosis without bandemia and elevated erythrocyte sedimentation rate (94 mm/h) and C-reactive protein (18.989 mg/dL). Chest X-ray was negative for infiltrate. Contrast magnetic resonance imaging of the lumbosacral spine revealed marrow enhancement of L3–4 including facet, multiloculated abscesses involving paraspinal musculature, epidural abscess, and cauda equina impingement [Figure 1]. Septic workup was obtained before empirically starting vancomycin and piperacillin-tazobactam. Computed tomography-guided aspiration of the paraspinal abscesses was completed, followed by surgical evacuation of epidural abscess and laminectomy due to worsening neurologic deficits. Two days later, blood cultures taken on admission and before surgical intervention revealed growth of penicillin-sensitive S. pneumoniae. Extracted purulent materials expressed the presence of many white blood cells on Gram stain but no organisms. After surgical intervention, the patient's pain and neurologic function significantly improved and defervescence with continued antibiotics. He was subsequently deemed stable for discharge. Given the sensitivity profile of the pneumococcus isolated as well as the extent and severity of illness, he was treated with ceftriaxone 2 g twice daily for 6 weeks. Upon completion of antibiotic therapy, repeat magnetic resonance imaging noted resolution of bone marrow signaling changes.

View Article: PubMed Central - PubMed

ABSTRACT

Streptococcus pneumoniae vertebral infections have rarely been reported. Herein, we report a case of pneumococcal vertebral osteomyelitis with paraspinal and epidural abscesses as well as concomitant bacteremia following epidural injection. This will be the second case in the literature reporting pneumococcal vertebral osteomyelitis related to epidural manipulation.

No MeSH data available.


Related in: MedlinePlus