Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review

Abstract

Background Spinal epidural abscess is a rare but serious condition that can cause spinal cord compression and neurological deficits.

Case Description and Methods The article reports a case of a 31-year-old patient who presented with an infectious cellulitis in the left hand, which progressed to a spinal epidural abscess. The diagnosis was confirmed by clinical examination and magnetic resonance imaging. Treatment involved laminectomy, after which the patient had complete recovery of neurological deficits. This article is a case report with a literature review. Patient data and images were collected by the researchers who participated in the patient's care. The literature was reviewed by one of the researchers based on the search for articles in the PubMed database. For the research, the following keywords were inserted: “Spinal epidural empyema,” “Spinal epidural abscess.”

Conclusion Spinal epidural abscess is often underdiagnosed, which can lead to delays in treatment and serious complications. The relationship between cellulitis and spinal epidural abscess may be related to the spread of infection through the lymphatic or blood system.

Keywords

infectious cellulitis - spinal epidural abscess - paraplegia - case report - review

Publication History

Received: 04 July 2023

Accepted: 14 January 2024

Accepted Manuscript online:
13 February 2024

Article published online:
08 April 2024

• References

• 1 Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 2000; 23 (04) 175-204 , discussion 205
• 2 Aycan A, Aktas OY, Guzey FK. et al. Rapidly progressive spontaneous spinal epidural abscess. Case Rep Infect Dis 2016; 2016: 7958291
• 3 Cao J, Fang J, Shao X, Shen J, Jiang X. Case Report: a case of cervical spinal epidural abscess combined with cervical paravertebral soft tissue abscess. Front Surg 2022; 9: 967806
• 4 Houshian S, Seyedipour S, Wedderkopp N. Epidemiology of bacterial hand infections. Int J Infect Dis 2006; 10 (04) 315-319
• 5 Abdelhakim K, Bakir MS, Fargen KM, Raper DM. A classification system for spinal cord compression and its association with neurological deficit in spinal epidural abscess. J Neurosurg Spine 2017; 26 (05) 573-578
• 6 Rosc-Bereza K, Arkuszewski M, Ciach-Wysocka E, Boczarska-Jedynak M. Spinal epidural abscess: common symptoms of an emergency condition. A case report. Neuroradiol J 2013; 26 (04) 464-468
• 7 Zhang JH, Wang ZL, Wan L. Cervical epidural analgesia complicated by epidural abscess: a case report and literature review. Medicine (Baltimore) 2017; 96 (40) e7789
• 8 Darouiche RO. Spinal epidural abscess. N Engl J Med 2006; 355 (19) 2012-2020
• 9 Khanna RK, Malik GM, Rock JP, Rosenblum ML. Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery 1996; 39 (05) 958-964
• 10 Centers for Disease Control Prevention. Active bacterial core surveillance (ABCs) report. Emerging infections program net- work. Group A Streptococcus—2015. Accessed October 1, 2017 at: https://www.cdc.gov/abcs/reports-findings/survreports/gas15.pdf.
• 11 Shah AA, Ogink PT, Harris MB, Schwab JH. Development of predictive algorithms for pre-treatment motor deficit and 90- day mortality in spinal epidural abscess. J Bone Joint Surg Am 2018; 100 (12) 1030-1038
• 12 Agrawal V, Viswanathan S, Selvaraj J, Pillai V. Streptococcus gallolyticus-related spinal epidural abscess. BMJ Case Rep 2022; 15 (08) e250733
• 13 Usuda D, Taki Y, Izumida T. et al. Disseminated spinal epidural abscess in an immunocompetent individual: a case report and review of the literature. J Med Cases 2020; 11 (12) 417-425
• 14 Chenoweth CE, Bassin BS, Mack MR. et al. Vertebral Osteomyelitis, Discitis, and Spinal Epidural Abscess in Adults. Ann Arbor, MI:: Michigan State University;; 2018
• 15 Connor Jr DE, Chittiboina P, Caldito G, Nanda A. Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome. J Neurosurg Spine 2013; 19 (01) 119-127
• 16 Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992; 71 (06) 369-385
• 17 Sati WO, Haddad M, Anjum S. A case of spinal epidural abscess presenting with horner syndrome. Cureus 2021; 13 (04) e14541
• 18 Shin W, Oh JH, Cho AY. et al. A rare case of spinal epidural abscess following urinary tract infection caused by escherichia coli in a patient with pre-existing stress fractures of the lumbar spine. Korean J Fam Med 2022; 43 (02) 147-149
• 19 Ameer MA, Knorr TL, Mesfin FB. Spinal Epidural Abscess. Mar 31, 2020. In: StatPearls [Internet]. Treasure Island, FL:: StatPearls Publishing;; 2020
• 20 Spennato P, Renedo D, Cascone D. et al. Spinal epidural abscess in children: a case-based review. Childs Nerv Syst 2020; 36 (07) 1385-1392
• 21 Kim C, Lee S, Kim J. Spinal epidural abscess due to coinfection of bacteria and tuberculosis: a case report. World J Clin Cases 2021; 9 (16) 4072-4080
• 22 Rashid MH, Hossain MN, Ahmed N. et al. Aspergillus spinal epidural abscess: a case report and review of the literature. J Craniovertebr Junction Spine 2022; 13 (02) 204-211
• 23 Rigamonti D, Liem L, Sampath P. et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1999; 52 (02) 189-196 , discussion 197
• 24 Sahu KK, Chastain I. A rare case of holocord spinal epidural abscess. QJM 2020; 113 (04) 302-303
• 25 Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine 2011; 14 (06) 765-770
• 26 Davis DP, Wold RM, Patel RJ. et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med 2004; 26 (03) 285-291
• 27 Xu T, Du Y, Guo J. et al. Extensive spinal epidural abscess resulting in complete paraplegia treated by selective laminectomies and irrigation. Orthop Surg 2022; 14 (09) 2380-2385
• 28 Shikano K, Ishii D, Umimura T. et al. Spondylodiscitis and spinal epidural abscess related to long-term placement of an airway stent for malignant central airway obstruction. Thorac Cancer 2020; 11 (08) 2343-2346
• 29 Arko IV L, Quach E, Nguyen V, Chang D, Sukul V, Kim BS. Medical and surgical management of spinal epidural abscess: a systematic review. Neurosurg Focus 2014; 37 (02) E4
• 30 Göre B, Yenigün EC, Cevher ŞK, Çankaya E, Aydın N, Dede F. IGA nephropathy and spinal epidural abscess after COVID-19 infection: a case report. Future Virol 2022; 17 (09) 611-615
• 31 Gupta KM, Tay KY. Spinal epidural abscess in an infant presenting as fever and respiratory distress. Pediatr Emerg Care 2020; 36 (11) e649-e650
• 32 Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med 1948; 239 (23) 845-854
• 33 Hirai N, Kasahara K, Yoshihara S. et al. Spinal epidural abscess caused by non-typhoidal Salmonella: a case report and literature review. J Infect Chemother 2020; 26 (10) 1073-1077
• 34 Mor YS, Rizwan A, Frank A. Paraplegia from a spinal epidural abscess caused by pasteurella multocida. Cureus 2021; 13 (06) e15477
• 35 Baker AS, Ojemann RG, Swartz MN, Richardson Jr EP. Spinal epidural abscess. N Engl J Med 1975; 293 (10) 463-468
• 36 Munasinghe BM, Pathirage N, Hameed MS, Hapuarachchi CT. Pus in spinal needle: diagnosis and management of a long-segment spinal epidural abscess. Case Rep Infect Dis 2021; 2021: 9989847 ( Erratum in: Case Rep Infect Dis. 2021 Aug 11;2021:9893619. PMID: 34007497; PMCID: PMC8100421)
• 37 Polsky Z, Dowling SK, Jacobs WB. Just the facts: risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department. CJEM 2020; 22 (06) 753-755
• 38 Vig KS, Amarante M, Hutchinson I, Lawrence JP. Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: an operative case report. N Am Spine Soc J 2021; 6: 100067
• 39 Scalia G, Marrone S, Paolini F. et al. Spinal epidural abscess due to acute pyelonephritis. Surg Neurol Int 2022; 13: 159
• 40 Last's Anatomy. 12th edition. England: Churchill Livingstone. 2011. ISBN:0702033944
• 41 Ma CX, Pan WR, Liu ZA, Zeng FQ, Qiu ZQ, Liu MY. Anatomia linfática profunda do membro superior: estudo anatômico e implicações clínicas. Ana Anat 2019; 223: 32-42
• 42 Radkowski CA, Richards RS, Pietrobon R, Moorman CT. Estudo anatômico da veia cefálica na abordagem do ombro deltopeitoral. Clin Orthop Relat Res 2006; 442: 139-142
• 43 Van Baarsel ED, Kesbeh Y, Kahf HA, Patel V, Weng B, Sutjita M. Spinal epidural abscess secondary to gram-negative bacteria: case report and literature review. J Community Hosp Intern Med Perspect 2020; 10 (01) 60-64
• 44 Kharbat AF, Cox CT, Purcell A, MacKay BJ. Methicillin-resistant Staphylococcus aureus spinal epidural abscess: local and systemic case management. Cureus 2022; 14 (03) e22831
• 45 Ammar AA, Hamad MK, Obeidallah MS, Kobets AJ, Lee SK, Abbott IR. Successful treatment of pediatric holo-spinal epidural abscess with percutaneous drainage. Cureus 2022; 14 (05) e24735
• 46 Chaker AN, Bhimani AD, Esfahani DR. et al. Epidural abscess: a propensity analysis of surgical treatment strategies. Spine 2018; 43 (24) E1479-E1485
• 47 Papaetis GS, Petridis TA, Karvounaris SA, Demetriou T, Lykoudis S. Bacteroides fragilis bacteremia complicated by spondylodiscitis, spinal epidural abscess, and sepsis: a case report. Am J Case Rep 2022; 23: e936179
• 48 Fujita M, Ueno T, Horiuchi M. et al. Campylobacter coli infection causes spinal epidural abscess with Guillain-Barré syndrome: a case report. BMC Neurol 2022; 22 (01) 9
• 49 Davis DP, Wold RM, Patel RJ. et al. Spinal epidural abscess: diagnosis, management, and outcomes. West J Emerg Med 2014; 15 (01) 1-8
• 50 Nitinai N, Punpichet M, Nasomsong W. Fatal cervical spinal epidural abscess and spondylodiscitis complicated with rhombencephalitis caused by klebsiella pneumoniae: a case report and literature review. Cureus 2021; 13 (12) e20100
• 51 Horiya M, Anno T, Kawada M. et al. Pyogenic psoas abscess on the dorsal side, and bacterial meningitis and spinal epidural abscess on the ventral side, both of which were induced by spontaneous discitis in a patient with diabetes mellitus: a case report. J Diabetes Investig 2021; 12 (07) 1301-1305
• 52 Mallik J, Motiani V, Pai MG. Spinal epidural abscess post spinal anesthesia: an uncommon complication of a common procedure. Asian J Neurosurg 2020; 15 (03) 730-732
• 53 Lodhi FAK, Shogren SL, Haque N, Ishaq M, Rehman A. Spinal epidural abscess due to Pasteurella multocida infection. IDCases 2020; 21: e00801
• 54 Altdorfer A, Gavage P, Moerman F. Aggregatibacter aphrophilus spinal epidural abscess. BMJ Case Rep 2020; 13 (07) e235320
• 55 Brunasso L, Basile L, Gerardo Iacopino D. et al. All that glitters is not gold: a spinal epidural empyema following epidural steroid injection. Surg Neurol Int 2020; 11: 240
• 56 Plancha da Silva T, Amaral Silva M, Santos Boaventura S, Castro Martins M, Teixeira Duro S, Carvalho F. Spinal cord disorder due to spinal epidural abscess secondary to thoracic facet joint septic arthritis-a rare case with a surprising evolution. Spinal Cord Ser Cases 2020; 6 (01) 102
• 57 Maiese A, Volonnino G, Viola RV. et al. A rare case of Spinal Epidural Abscess following mesotherapy: a challenging diagnosis and the importance of clinical risk management. Considerations concerning uncommon risk factor for development of Spinal Epidural Abscess and its prevention. Clin Ter 2020; 170 (01) e15-e18