Transoral approach to drain streptococcus pneumoniae spinal epidural abscess in an HIV-infected adult

Acta Oto-laryngologica
Pedro BenítezJoaquim Mullol

Abstract

Spinal epidural abscess due to Streptococcus pneumoniae is extremely rare in adults. It typically occurs in the thoracic, lumbar or lumbosacral epidural spaces, and less frequently in the cervical epidural space. The principal causative microbial agent is Staphylococcus aureus, representing 70% of cases, while 1.6% of cases are caused by S. pneumoniae. We report the first case of an HIV-infected patient with a cervical spinal epidural abscess. The patient was a 43-year-old male with pneumococcal bacteremia and a metatarsal abscess. He reported cervical pain with muscle spasm during cephalic flexion and extension, fever and a painful tumefaction on the second metatarsal of the left foot. MRI confirmed that the retropharyngeal abscess extended to the cervical spinal epidural space. Antibiotic therapy with cefotaxime plus vancomycin was initiated and a transoral surgical approach was used to achieve retropharyngeal and local debridement of the metatarsal abscess. Blood and pus cultures were positive for S. pneumoniae. After 4 months of follow-up the patient remained asymptomatic, without clinical or MRI evidence of recurrence.

References

Sep 1, 1996·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·R E FrankelG Friedland
Dec 2, 1948·The New England Journal of Medicine·A P HEUSNER

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Citations

Jul 21, 2011·Asian Pacific Journal of Tropical Medicine·Chandrakant PatilBlenda D'Souza
Feb 1, 2014·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·D M SiddiqR O Darouiche
Apr 6, 2012·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Ali A BaajMark S Greenberg
Aug 29, 2009·European Journal of Internal Medicine·Julio J González-LópezManuel L Fernández Guerrero
Nov 18, 2008·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Shiuan-Horng ChernJiun-Ling Wang
Feb 5, 2014·Veterinary and Comparative Orthopaedics and Traumatology : V.C.O.T·E LinonF Forterre

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