期刊
WORLD JOURNAL OF CLINICAL CASES
卷 9, 期 16, 页码 4072-4080出版社
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.12998/wjcc.v9.i16.4072
关键词
Bacteremia; Coinfection; Epidural abscess; Tuberculosis; Case report
Spinal epidural abscess (SEA) is a rare condition caused by infection with bacteria or tuberculosis, with coinfection being extremely rare. In this case, the patient underwent two surgeries and eventually fully recovered through anti-tuberculosis treatment.
BACKGROUND Spinal epidural abscess (SEA) is a rare condition that mostly results from infection with either bacteria or tuberculosis. However, coinfection with bacteria and tuberculosis is extremely rare, and it results in delays in diagnosis and antimicrobial treatment causing unfavorable outcomes. CASE SUMMARY A 75-year-old female visited the hospital with low back pain, and magnetic resonance imaging (MRI) revealed an SEA at the lumbosacral segment. Staphylococcus hominis and methicillin-resistant Staphylococcus epidermidis were identified from preoperative blood culture and intraoperative abscess culture, respectively. Thus, the patient underwent treatment with vancomycin medication for 9 wk after surgical drainage of the SEA. However, the low back pain recurred 2 wk after vancomycin treatment. MRI revealed an aggravated SEA in the same area in addition to erosive destruction of vertebral bodies. Second surgery was performed for SEA removal and spinal instrumentation. The microbiological study and pathological examination confirmed Mycobacterium tuberculosis as the pathogen concurrent with the bacterial SEA. The patient improved completely after 12 mo of antitubercular medication. CONCLUSION We believe that the identification of a certain pathogen in SEAs does not exclude coinfection with other pathogens. Tubercular coinfection should be suspected if an SEA does not improve despite appropriate antibiotics for the identified pathogen.
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