Vertebral osteomyelitis and epidural abscess caused by gas gangrene presenting with complete paraplegia: a case report

Abstract

IntroductionGas gangrene is most often caused by Clostridium perfringens infection. Gas gangrene is a medical emergency that develops suddenly. The mortality rate is higher with trunk involvement than with involvement of the extremities, which carries a better prognosis. With respect to vertebral involvement, there are few reports in the literature. The purpose of this paper is to report a very rare case of vertebral osteomyelitis caused by gas gangrene.Case presentationA 78-year-old Japanese woman with diabetes mellitus was admitted to our hospital with the chief complaints of back pain, dysuria, and complete paralysis of both legs. A computed tomography scan showed soft tissue swelling anterolaterally at intervertebral disc level T11/12 and a gas-containing epidural abscess that compressed her spinal cord. Cultures later grew Clostridium perfringens and Escherichia coli. Hemilaminectomy was done from T10 to T12, and an epidural abscess was removed. She went on to have fusion surgery 6 weeks after the initial operation and subsequently experienced complete pain relief. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane.ConclusionsDiscitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.

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

“…Spinal epidural abscess caused to by E. coli is an uncommon disease with very few cases described in the literature. The case reports describing epidural abscess caused by E. coli had been secondary to genitourinary conditions as urinary tract infections, pyelonephritis, prostatitis, and transrectal US prostate biopsy [3–12]. These reported cases had preexisting risk factors for epidural abscess such as diabetes, obesity, alcoholism, trauma, and bone degeneration.…”

“…These reported cases had preexisting risk factors for epidural abscess such as diabetes, obesity, alcoholism, trauma, and bone degeneration. Three cases were reported as spontaneous SEA with no associated risk factors [6, 9, 12]. The most common presentation reported was fever with neck or back pain and tenderness.…”

Pneumorachis from the cervical to the sacral spinal canal with spinal epidural abscess by gas gangrene

“…While the most reported pathogen is S. aureus , E. coli has been identified in only one paper, and the route of infection is not evident. 10…”

“…To the best of our knowledge, only 10 reports of pneumorachis with epidural abscess have been identified, and in most of these cases, the gas is observed in a limited region in the spinal canal. 3 –12…”

“…To the best of our knowledge, only 10 reports of pneumorachis with epidural abscess have been identified, and in most of these cases, the gas is observed in a limited region in the spinal canal. [3][4][5][6][7][8][9][10][11][12] Epidural abscess is a rare and potentially serious pyogenic infection. 13 Urgent surgical intervention is one of the management methods of epidural abscess, but with earlier diagnosis based on computed tomography (CT) and magnetic resonance imaging (MRI), some studies indicate successful outcomes with nonoperative medical treatment alone.…”