Cervical Spinal Osteomyelitis with Epidural Abscess following an Escherichia coli Urinary Tract Infection in an Immunocompetent Host

Abstract

Spinal epidural abscess (SEA) is uncommon with an incidence reported as 0.33–1.96 abscesses per 10,000 hospital admissions per year. Two-thirds of the cases were caused by Staphylococcus aureus. Escherichia coli (E. coli) is a less common cause of SEA, and it is usually after urinary tract infection in patient with preexisting risk factor. A 69-year-old male with a past medical history significant for prostatitis was admitted with fever, altered mental status, neck pain, progressive lower extremities weakness, and frequent falls for 7 days. Both blood and urine cultures grew E. coli. Lumbar puncture showed 94 RBCs, 24 WBCs (16% neutrophils and 46% lymphocytes), and elevated protein level at 1140 mg/dl with no bacteria. C-spine MRI showed epidural abscess along the anterior and right lateral margin of the cord causing cord compression from C5 through C7, anterior perivertebral abscess from C4 through T2, marrow edema involving C6 and C7 vertebral bodies with increased signal in the intervertebral disc space at C6-C7, and consistent with osteomyelitis and discitis. Anterior cervical decompression with evacuation of anterior epidural abscess with fusion was done. The culture from the epidural abscess grew E coli. A diagnosis of SEA should be considered in patients presenting with progressive weakness and neurological deficits following UTI and is to be confirmed by MRI. E. coli could be the culprit for epidural abscess and spine osteomyelitis even in immunocompetent patients.

A unique case of metastatic spinal epidural abscess associated with liver abscess following ascending cholangitis and Escherichia coli bacteremia

“…Though extremely rare, cases of SEA caused by E coli following urinary tract infections have been reported [19,20]. To the best of our knowledge, this is the irst case report describing SEA due to E. coli bacteremia following a PLA.…”

Acute Hematogenous Escherichia coli Osteomyelitis of the Fibula in an Adolescent Girl

“…The ExPEC strains typically possess multifarious virulence factors, which enable them to overpower the host defense mechanisms in both healthy and immunocompromised individuals at all ages; nevertheless, the incidence of the infection increases with the patient's age (14)(15)(16). In older adults, osteomyelitis usually results from the hematogenous spread of bacteria from the urinary system, seeding the vertebrae or pelvis (18,19). In children with AHO, E. coli is an unusual pathogen and accounts for only 0.6% to 3% of cases, typically affecting the long tubular bones (11,13).…”

Surgical Management of Thoracic Osteomyelitis due to Escherichia Coli Sepsis

“…Adults are much more often afflicted with vertebral osteomyelitis than children. Males more affected and medical comorbidities including immunosuppression, diabetes, and neoplastic disease predispose patients to vertebral osteomyelitis [ 2 , 3 , 7 ]. The presenting symptoms are generally nonspecific but commonly include progressive back pain and fever.…”

“…The most common bacterial pathogen resulting in spinal osteomyelitis is Staphylococcus aureus . Vertebral osteomyelitis due to E coli is rare [ 3 , 4 , 6 , 7 ]. The most common source for E coli osteomyelitis is secondary to genitourinary conditions [ 7 ].…”