Cervical Spondylodiscitis with Epidural and Paraspinal Abscess: case report and literature review

Espondilodiscite Cervical com Abscesso Epidural e Paraespinhal: relato de caso e revisão da literatura

Manuela Guedes Pereira 1
Pedro Henrique Simm Pires de Aguiar 2
Mariana da Silveira Munoz Vasques 3
Vitória Bernal Cavalcanti 4
Paulo Henrique Pires de Aguiar 5
Joseph Buwembo 6

https://doi.org/10.22290/jbnc.2024.350201
J Bras Neurocirur 35 (2):108-112, 2024

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Resumo

Introdução: O abscesso epidural espinhal (AEE) foi descrito pela primeira vez em 1761 por Giovanni Morgagni como uma infecção supurativa do sistema nervoso central envolvendo o espaço entre a dura-máter espinhal e o periósteo vertebral. Relato do caso: Paciente do sexo feminino, 39 anos, portadora de Staphylococcus aureus resistente à meticilina (MRSA) e positiva para hepatite C. Diagnosticada com osteomielite em C6-C7 com abscessos pré-vertebrais e paraespinhais posteriores com colapso vertebral associado e cifose cervical no nível de C6-C7. Usuária de drogas ilícitas. Apresentou AEE, caso não tão comum quanto as outras infecções do sistema nervoso. Discussão: O uso de drogas intravenosas ilícitas é um problema bastante comum e leva a infecções com risco de vida em muitos pacientes que acabam internados em hospitais. Características comuns de apresentação incluem bacteremia, endocardite, osteomielite e discite com abscesso epidural, miosite com abscesso e infecções virais crônicas como hepatite B, C e SIDA. Conclusão: O uso de drogas ilícitas pode levar a infecções potencialmente fatais. Nossa paciente demonstrou o ônus econômico do tratamento de infecções relacionadas ao uso de drogas ilícitas intravenosas; O tratamento cirúrgico corrigiu a grave deformidade cifótica em nossa paciente.

Palavras-chave

Abscesso epidural espinhal; Osteomielite; Deformidade cifótica; Drogas ilícitas intravenosas

Abstract

Introduction: Spinal epidural abscess (SEA) was first described in 1761 by Giovanni Morgagni as a suppurative central nervous system infection involving the space between the spinal dura and vertebral periosteum. Case presentation: We report a 39 years old female patient. The patient had Methicillin-resistant Staphylococcus aureus (MRSA) and is Hepatitis C positive. She was diagnosed with osteomyelitis at C6-C7 with prevertebral and posterior paraspinal abscesses with associated vertebral collapse and cervical kyphosis at the C6-C7 level. She is IV illicit drug abuser. She presented with SEA, which is not as common as other nervous system infections. Discussion: Illicit intravenous drug use is a fairly common problem, and it leads to life threatening infections in many patients who end up admitted to hospitals. Common presenting features include bacteremia, endocarditis, osteomyelitis and discitis with epidural abscess, myositis with abscess and chronic virus infections as Hepatitis B, C and HIV. Conclusion: Illicit drug use can lead to life threatening infections; our patient demonstrated the economic burden of treating infections related to illicit IV drug use. The surgical management corrected the severe kyphotic deformity in our patient.

Keywords

Spinal epidural abscess; Osteomyelitis; Kyphotic deformity; Intravenous illicit drugs

References

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1MS, Medical student, Faculdade de Medicina de Catanduva. Neurosurgery Observership, Stanford Hospital, Palo Alto, CA, USA. Neurosurgery Observership, Saskatchewan Health Hospitals,

Regina and Saskatoon, SK, Canada.

2MS, Medical student, Pontificia Universidade Católica (PUC). Neurosurgery Observership, Stanford Hospital, Palo Alto, CA, USA. Neurosurgery Observership, Saskatchewan Health Hospitals,

Regina and Saskatoon, SK, Canada.

3MS, Medical student, Faculdade de Medicina de Jundiaí. Neurosurgery Observership, Saskatchewan Health Hospitals, Regina and Saskatoon, SK, Canada.

4MS, Medical student, Pontificia Universidade Católica (PUC). Neurosurgery Observership, Saskatchewan Health Hospitals, Regina and Saskatoon, SK, Canada.

5MD, PhD, Neurosurgeon, Professor at Faculdade de Medicina do ABC, PUC-SP and Catanduva, SP, Brasil.

6MB-ChB, FCS(SA), MMeD, FRCSC, Neurosurgeon, Division Head and Clinical Associate Professor, Division of Neurosurgery, Department of Surgery, College of Medicine, University of

Saskatchewan, Regina General Hospital, Canada.

Received Mar 13, 2024

Accepted May 28, 2024