Cervical Epidural Abscess: Rare Complication of Bacterial Endocarditis with Streptococcus Viridans: A Case Report

Oh, Jae Sang; Shim, Jai-Joon; Lee, Kyeong-Seok; Doh, Jae-Won

doi:10.14245/kjs.2015.12.1.22

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…While S. mitis is a leading cause of infective endocarditis (IE) among the oral streptococci, to our knowledge, this is only the second case in which spinal epidural abscess (SEA) has been reported in association with S. mitis IE [ 6 ]. SEA is a rare complication of VGS-related IE in general; only eleven cases of vertebral osteomyelitis complicating VGS endocarditis have been previously reported [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Infective Endocarditis and Spinal Epidural Abscess Caused by Streptococcus mitis Bacteremia

Byrd

Németh

2017

Case Reports in Infectious Diseases

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A 57-year-old man presented with abdominal pain, hematemesis, and melena. He reported taking high-dose ibuprofen for back pain and drinking several 24-ounce beers daily. Examination was remarkable for icteric sclera, poor dentition, tachycardia, and crescendo-decrescendo murmur at right upper sternal border, radiating to the carotids. Labs revealed leukocytosis, anemia, thrombocytopenia, and elevated liver function tests and INR. Endoscopy demonstrated antral ulcers, duodenitis, and esophagitis. Blood cultures were obtained and broad-spectrum antibiotics started; cultures later grew Streptococcus mitis, and antibiotic coverage was narrowed. Transthoracic echocardiogram (TTE) demonstrated aortic stenosis and regurgitation, but no vegetation. Repeat blood cultures were negative; however, the patient developed neurological symptoms concerning for cauda equina syndrome, and MRI revealed epidural abscess. Emergent decompression could not be performed as the patient developed hematemesis and required intubation. Transesophageal echocardiogram (TEE), initially deferred due to friable esophageal mucosa, was performed and revealed small aortic valve vegetation. Poor oral hygiene was felt to be the probable source of the patient's S. mitis bacteremia, epidural abscess, and infective endocarditis. The patient's neurological symptoms resolved without intervention and remaining teeth were extracted. This case demonstrates that Streptococcus mitis can result in clinically significant bacteremia, particularly in immunocompromised patients, including chronic heavy alcohol users.

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Section: Discussionmentioning

confidence: 99%

A Case of Infective Endocarditis and Spinal Epidural Abscess Caused by Streptococcus mitis Bacteremia

Byrd

Németh

2017

Case Reports in Infectious Diseases

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“…presented a patient with a cervical SEA due to streptococcus viridans endocarditis that was successfully treated with IV antibiotics for 8 weeks without sequelae [ Table 3 ]. [ 21 ]…”

Section: Summaries Of Studies Involving 1 To <40 Cases Of Spinal Epidmentioning

confidence: 99%

Timing and prognosis of surgery for spinal epidural abscess: A review

Epstein¹

2015

Surg Neurol Int

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Background:The nonsurgical versus surgical management of spinal epidural abscesses (SEAs) remains controversial. Even with the best preoperative screening for multiple risk factors, high nonoperative failure rates are attended by considerable morbidity (e.g., irreversible paralysis) and mortality. Therefore, the focus remains on early surgery.Methods:Most papers promote early recognition of the clinical triad (e.g., fever [50%], spinal pain [92–100%], and neurological deficits [47%]) for SEA. They also identify SEA-related risk factors for choosing nonsurgical versus surgical approaches; advanced age (>65 or 80), diabetes (15–30%), cancer, intravenous drug abuse (25%), smoking (23%), elevated white blood cell count (>12.5), high C-reactive protein >115, positive blood cultures, magnetic resonance imaging/computed tomographic documented cord compression, and significant neurological deficits (e.g., 19–45%).Results:Surgical options include: decompressions, open versus minimally invasive biopsy/culture/irrigation, or fusions. Up to 75% of SEA involve the thoracolumbar spine, and 50% are located ventrally. Wound cultures are positive in up to 78.8% of cases and are often (60%) correlated with positive blood cultures. The most typical offending organism is methicillin resistant Staphylococcus aureus, followed by methicillin sensitive S. aureus. Unfortunately, the failure rates for nonoperative treatment of SEA remain high (e.g., 41–42.5%), contributing to significant morbidity (22% risk of permanent paralysis), and mortality (3–25%).Conclusion:The vast majority of studies advocated early surgery to achieve better outcomes for treating SEA; this avoids high failure rates (41–42.5%) for nonoperative therapy, and limits morbidity/mortality rates.

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“…Spondylodiscitis and paraspinal abscesses can be either nidus for bacteremia and IE, as in our case, or as a result of embolic event from IE itself. Detailed history and high index of suspicion is required in case of combined IE and Spondylodiscitis in order to determine which one is the primary source of infection and manage patient properly [ 16 , [18] , [19] , [20] ]).…”

Section: Discussionmentioning

confidence: 99%

Native tricuspid valve infective endocarditis with Staphylococcus lugdunesis: An unusual complication post spinal epidural injection – Case report and literature review

Alkhalaila

Tbishat

Abdelghani

et al. 2021

IDCases

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Infective Endocarditis (IE) is a very rare complication following spinal epidural injection and requires high index of suspicion for early diagnosis and effective management. Staphylococcus Lugdunesis is a coagulase negative staphylococcus (CoNS) that, unlike other CoNS, may result in aggressive form of native valve infective endocarditis (IE) mimicking IE caused by S aureus. Surgical intervention is usually needed to control infection in most cases of S. Lugdunesis IE. Herein, we report a case of young lady with congenital Gerbode defect who developed tricuspid native valve IE with S. Lugdunesis secondary to spondylodiscitis post lumbar epidural injection that was performed for disk prolapse. She required urgent surgical intervention and had an excellent outcome.

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Cervical Epidural Abscess: Rare Complication of Bacterial Endocarditis with Streptococcus Viridans: A Case Report

Cited by 12 publications

References 19 publications

A Case of Infective Endocarditis and Spinal Epidural Abscess Caused by Streptococcus mitis Bacteremia

A Case of Infective Endocarditis and Spinal Epidural Abscess Caused by Streptococcus mitis Bacteremia

Timing and prognosis of surgery for spinal epidural abscess: A review

Native tricuspid valve infective endocarditis with Staphylococcus lugdunesis: An unusual complication post spinal epidural injection – Case report and literature review

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