Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

Abstract

Background Intramedullary abscesses are rare infections of the spinal cord. Intramedullary abscesses often have a complex presentation, making a high index of suspicion essential for prompt diagnosis and management. Case presentation We present two cases of intramedullary abscesses referred to and ultimately managed at our institution. Delayed diagnosis occurred in both instances due to the rarity of intramedullary abscesses and their propensity to mimic other pathologies. For both patients, prompt surgical management and the rapid institution of broad-spectrum antibiotics were critical in preventing further neurological decline. Conclusions Although rare, it is critical to consider intramedullary abscesses on the differential for any MRI lesions that are hyperintense on T2 and peripherally enhancing on T1 post-contrast sequences, as even short delays in treatment can lead to severe neurological damage.

Intramedullary Spinal Cord Abscess with Concomitant Spinal Degenerative Diseases: A Case Report and Systematic Literature Review

“…However, there were too few data in the death group about time from symptoms to treatment; information was only available in one case (10%). Ten patients (14.2%) died postoperatively: as a result of septic embolus with concomitant pyelonephritis in [ 19 ], UTI [ 6 , 33 ], chronic alcoholism and bronchopneumonia in case [ 52 ], disseminated coccidioidomycosis [ 28 ], multiple cerebral abscesses complicated by progressive hydrocephalus [ 53 ], abscess rupture inducing meningitis and brain abscess [ 53 ], Listeria meningoencephalitis [ 12 ], central nervous system nocardiosis involving the bilateral hemisphere, cerebellum, and upper cervical spinal cord due to diabetes mellitus (despite a two-stage operation) [ 20 ], cardiac arrest [ 51 ], intracranial extension of her spinal aspergillosis resulting in rapid progression of ventriculitis and cerebral vasculitis with diffuse vascular occlusion and widespread cerebral infarction [ 51 ], and refractory septic shock [ 60 ]. There were no significant differences in the time until treatment among the recovery, persistent, residual and death prognosis groups ( p = 0.613).…”

“…Spinal cord tumors (necrotic glioma, metastases), resolving hematoma, infarction, granulomatous disease, and demyelinating disease (multiple sclerosis) can be included in the radiographic differential diagnosis of a ring-enhancing mass [ 36 , 91 ]. Hyperintensity on T2-weighted images tends to resolve markedly as infections are suppressed by treatment [ 12 , 92 ]. An ISCA that could require immediate surgery should always be considered, although MRI features can resemble those of a tumor, which would not necessarily be considered for immediate resection.…”

“…Bartel et al reported a higher incidence in women during their first four decades, whereas men had a constant incidence throughout their lifetime [ 11 ]. A high index of suspicion of ISCA is crucial for prompt diagnosis, effective clinical management, and supportive therapy, in order to prevent further neurological deterioration and to secure a favorable outcome [ 12 ].…”

Intramedullary spinal cord abscess with brain abscess due to subacute infective endocarditis

“…But sometimes the clinical manifestations may progress insidiously [ 9 ].The mechanisms of infection include hematogenous dissemination, contiguous spread from adjacent infection or infected dermal sinus, direct penetrating trauma, or septic emboli [ 10 ]. Many organisms can cause intramedullary abscesses, including Mycobacterium tuberculosis in the developing world and gram-positive cocci in the developed world [ 3 ]. In terms of clinical manifestations, the patient presented to our hospital complaining of head and neck pain and numbness in both lower extremities for 7 days.…”

“…Among them, the infection focus was infective endocarditis, accounting for 5% [ 2 ]. ISCA is characterized by progressive back pain and neurological deficits, but clinical manifestations can also progress insidiously [ 3 ]. Spinal cord intramedullary abscesses have rapidly progressive symptoms, high mortality,and poor prognosis [ 4 ].…”