A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis

Abstract

Patient: Male, 60-year-old Final Diagnosis: Pyogenic spinal infection Symptoms: Low back pain • neck pain Medication: — Clinical Procedure: Fine needle biopsy • magnetic resonance imaging Specialty: Infectious Diseases • Rehabilitation Objective: Rare disease Background: Streptococcus oralis ( S. oralis ) is a gram-positive bacterium and component of the oral microbiota that can rarely cause opportunistic infection in the immunosuppressed. This report presents a 60-year-old man from Hong Kong with gingivitis and poorly controlled diabetes who visited his chiropractor with low back pain 2 weeks following mild COVID-19 and was diagnosed with paraspinal, psoas, and epidural abscess due to S. oralis . Case Report: The patient tested positive for COVID-19 when asymptomatic, then had a mild 10-day course of the illness, followed by low back pain 1 week later, prompting him to visit his primary care provider, who diagnosed sciatica and treated him with opioid analgesics. He presented to a chiropractor the following week, noting severe low back pain with radiation into the gluteal regions and posterior thighs, difficulty with ambulation, and mild neck pain. Considering the patient’s diabetes, widespread symptoms, and weakness, the chiropractor ordered whole-spine magnetic resonance imaging, which suggested possible multifocal spinal abscess and referred him urgently to a spine surgeon. The surgeon conducted testing consistent with bacterial infection, and referred to an infectious disease specialist, who confirmed S. oralis spinal infection via lumbar paraspinal needle biopsy and culture. The patient was first treated with oral antibiotics, then intravenous antibiotics in a hospital. Over 4 weeks, his spinal pain improved, and laboratory markers of infection normalized. Conclusions: This case illustrates an opportunistic pyogenic spinal infection including paraspinal, psoas, and epidural abscesses caused by S. oralis in an immunocompromised patient following COVID-19 illness.

Epidural Abscesses as a Complication of Interleukin-6 Inhibitor and Dexamethasone Treatment in a Patient with COVID-19 Pneumonia: A Case Report

“…Choudhury et al [18] reported a patient with recurrent and persistent MSSA bacteremia and osteomyelitis, complicated by a spinal epidural abscess, bioprosthetic valve endocarditis, and aortic root abscess despite antibiotic treatment while having tested positive for SARS-CoV-2 infection, implying a COVID-19-induced immunocompromised state with functional exhaustion of CD4 and CD8 T-cells as the potential underlying mechanism for the persistence of such infections. In a report by Chu et al [19], a 60-yearold patient with diabetes and gingivitis developed Streptococcus oralis spinal infection with paraspinal, psoas, and epidural abscesses one week after recovery from a mild COVID-19 infection. The patient had not received any immunosuppressive treatment but did have risk factors for spinal infection-gingivitis and diabetes-similar to the case presented in this report.…”

Bilateral Cellulitis Presented As Lower-Extremity Pain Reported in a Chiropractic Clinic: A Case Report

“…This study provides an important example of how challenging it can be to recognize an underlying infection in a patient with initial presentation of ankle pain. Although non-musculoskeletal conditions are rarely observed in chiropractic centers, cases involving infection and cardiovascular emergencies have been reported in the literature [ 19 , 20 ]. In the present case, a 71-year-old man with ankle pain was referred to a chiropractor who advised an MRI scan that revealed bilateral cellulitis.…”

Understanding the Utilization, Challenges, and Attitudes Towards Laboratory Testing and Radiological Imaging Among Chiropractors in Hong Kong: A Cross-Sectional Survey

“…However, an important aspect of chiropractic practice involves the diagnosis of neurological [14,15], gastrointestinal [16][17][18], and reproductive dysfunctions [19,20]. Additionally, considering the possibility of inflammatory arthritis [21,22], infections [23,24], cardiovascular diseases [25][26][27], systematic disorders [28], fractures [28,29], tendon ruptures [29,30], and metastatic conditions [31,32] that masquerade as musculoskeletal disorders is crucial for providing chiropractic care. Therefore, having access to laboratory testing and radiological imaging is vital for chiropractors to conduct comprehensive examinations, ruling out any underlying severe pathologies and ultimately enhancing the quality of life for their patients [33].…”