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Case Reports: Learning from unexpected outcome (positive or negative)
Streptococcus gallolyticus-related spinal epidural abscess
  1. Vineet Agrawal,
  2. Stalin Viswanathan,
  3. Jayachandran Selvaraj and
  4. Vivekanandan Pillai
  1. Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
  1. Correspondence to Dr Stalin Viswanathan; stalinviswanathan{at}ymail.com

Abstract

Spinal epidural abscess (SEA) is a surgical emergency if it causes paraplegia. Staphylococcus aureus and streptococci are the most common causes. Streptococcus gallolyticus has been reported to cause SEA only on three occasions earlier—all were associated with endocarditis or colonic malignancy. We report an older woman with diabetic ketoacidosis who presented with poorly localised back pain, fever and altered sensorium. Her lumbar puncture revealed frank pus, and MRI showed an SEA. She could not be weaned from mechanical ventilation post-surgical decompression, and she succumbed to ventilator-associated pneumonia. A triad of fever, back pain and neurological deficit should lead one to consider intraspinal suppuration. This report is the first S. gallolyticus-related SEA from India and the first in literature that was not associated with either endocarditis or colonic malignancy.

  • Diabetes
  • Meningitis
  • Infection (neurology)

http://dx.doi.org/10.1136/bcr-2022-250733

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    Footnotes

    • Contributors VA wrote the draft. SV edited the draft and performed literature search. JS made the concept and obtained images. VP cared for the patient and made the final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.