Spontaneous Pan-Vertebral Epidural Abscesses Caused by Streptococcus Intermedius in an Immunocompetent Patient

Odega Emmanuel^1, , Abolaji Atomode², Joseph Ogwuche Onah³ and Mustapha Abubakar⁴

¹Department of Emergency Medicine, Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, UK

²Department of Medicine, James Paget University Hospital NHS Foundation Trust, Norfolk, UK

³Royal Gwent Hospital, Cardiff, South Wales, UK

⁴Department of Medicine, Southend University Hospital NHS Trust, UK

Cite this paper:
Odega Emmanuel, Abolaji Atomode, Joseph Ogwuche Onah and Mustapha Abubakar. Spontaneous Pan-Vertebral Epidural Abscesses Caused by Streptococcus Intermedius in an Immunocompetent Patient. American Journal of Infectious Diseases and Microbiology. 2020; 8(4):127-131. doi: 10.12691/ajidm-8-4-2

Abstract

Spinal epidural abscess (SEA) is a rarely reported condition. Here, we present a unique case of a 54-year-old immunocompetent man who developed worsening lower back pain of 2 weeks duration. A full spine magnetic resonance imaging (MRI) was performed with contrast. This showed extensive epidural abscess extending from C2 to S2, more extensive around L5-S2, with left paraspinal, left iliopsoas and right psoas abscess confirming the diagnosis of spinal epidural abscess of the spine. Blood cultures grew Streptococcus intermedius, an anaerobic commensal bacterium of the normal flora of the mouth and upper airways. The patient was treated conservatively with intravenous Ceftriaxone 2g and oral Rifampicin 600mg. He was discharged on those medication for 10 weeks. There was remarkable improvement in his symptoms as he retained his baseline strength in his lower extremity and has regained function to the extent that he is independent with his activities of daily living. A high index of clinical suspicion and a low threshold of appropriate imaging, magnetic resonance imaging (MRI) being the gold standard, are important for accurate diagnosis. Though our patient was treated Medically, Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological deficits.

Keywords:
streptococcus intermedius spinal epidural abscess (SEA) immunocompetent

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