A Good Short-term Outcome in Delayed Decompression of Cauda Equina Syndrome in Klebsiella pneumoniae Spinal Epidural Abscess: A Case Report

Abstract

Spinal epidural abscess is a severe, generally pyogenic, infection of the epidural space of spinal cord or cauda equina. The swelling caused by the abscess leads to compression or vascular disruption of neurological structures that requires urgent surgical decompression to avoid significant permanent disability. We share a rare case of Klebsiella pneumoniae spinal epidural abscess secondary to haematogenous spread of previous lung infection that presented late at our centre with cauda equina syndrome that showed good short-term outcome in delayed decompression. A 50-year old female presented with one-week history of persistent low back pain with progressively worsening bilateral lower limb weakness for seven days and urinary retention associated with saddle anesthesia of 2-day duration. Magnetic resonance imaging with contrast of the lumbo-sacral region showed an intramuscular collection of abscess at left gluteus maximus and left multifidus muscle with a L3-L5 posteriorly placed extradural lesion enhancing peripherally on contrast, suggestive of epidural abscess that compressed the cauda equina. The pus was drained using the posterior lumbar approach. Tissue and pus culture revealed Klebsiella pneumoniae, suggestive of bacterial infection. The patient made immediate improvement of muscle power over bilateral lower limbs postoperative followed by ability to control micturition and defecation the 4th post-operative day. A good short-term outcome in delayed decompression of cauda equine syndrome is extremely rare. Aggressive surgical decompression combined with antibiotic therapy led to good short-term outcome in this patient despite delayed decompression of more than 48 hours.

Fatal Cervical Spinal Epidural Abscess and Spondylodiscitis Complicated With Rhombencephalitis Caused by Klebsiella pneumoniae: A Case Report and Literature Review

“…The most common causative pathogens are S. aureus and Streptococci. The concurrent adjacent spondylodiscitis commonly occurs owing to the contiguous spreading of microorganisms from the adjacent bone and disc, the most common route of infection [3,10]. Alcoholism, IVDU, diabetes mellitus, and immunocompromised status are the significant risk factors for SEA and spondylodiscitis [2].…”

“…Among gram-negative SEA and spondylodiscitis, promptly combined therapy of both surgical drainage and antimicrobial therapy remains crucial [11]. Eight of 10 patients with K. pneumoniae SEA from related reports encountered favorable outcomes after combined surgical and medical therapy [7][8][9][10]13,14]. However, only two cases recovered after being conservatively treated with antibiotics [6,11].…”

“…Klebsiella pneumoniae are the family members of Enterobacterales, which are capable of causing various types of community-acquired and healthcare-associated infection (HAI), e.g., pneumonia, internal organ abscess, and bacteremia [5]. Currently, few cases have been reported with isolated and spontaneous K. pneumoniae SEA [6][7][8][9][10][11][12][13][14]. Here, we report the case of fatal isolate and spontaneous K. pneumoniae spondylodiscitis and SEA involving C1-C7 complicated with rhombencephalitis in a patient with diabetes.…”