Cervical Osteomyelitis with Thoracic Myelitis and Meningitis in a Diabetic Patient

Abstract

A 45-year-old man with a history of untreated diabetes mellitus had a persisting fever, back pain, and diarrhea. The primary care physician diagnosed the patient with the flu and gastroenteritis. The patient developed paraplegia for two weeks and was admitted to another hospital. The physician in this hospital suspected infectious meningitis and myelitis, and administered piperacillin and steroids without cerebrospinal fluid (CSF) examination. On referral to our hospital, he presented a high fever and complete paraplegia. The lumbar puncture revealed a yellowish CSF, polynucleosis, and hypoglycorrhachia. Bacteria were not detected on Gram’s staining and were not confirmed by CSF culture. Magnetic resonance imaging (MRI) showed no thoracolumbar lesion and suggested a cervical epidural abscess without any spinal cord compression. He was diagnosed as having osteomyelitis with meningitis and thoracic myelitis. The infection subsided with broad-spectrum antibiotics. After two weeks, bilateral sensorimotor disturbances of the upper extremities appeared. MRI findings showed the epidural abscess compressing the cervical spinal cord. We performed debridement of the epidural abscess. The infection was clinically controlled by using another antibiotic. One month after the infection subsided, a 360° reconstruction was performed. In this case, the misdiagnosis and the absence of CSF examination and culture to detect the pathogenic bacteria at an earlier stage in the patient’s disease course might have led to the exacerbation of the pathology.

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

“…reported on a 45-year-old male with untreated diabetes, who presented paraparetic after 2 weeks of fever, back pain, and what was diagnosed as flu/gastroenteritis [ Table 3 ]. [ 22 ] With the original diagnosis of infectious meningitis/myelitis, he was presumptively given piperacillin and steroids (e.g., no cerebrospinal fluid [CSF] study). At the next institutions, with a high fever and full-blown paraplegia, he underwent a lumbar puncture that revealed a yellowish CSF, characterized by polynucleosis, and hypoglycorrhachia but with a negative Gram-stain/culture.…”

Vertebral osteomyelitis in bacterial meningitis patients

“…The search yielded 65 articles of which 31 studies were relevant to our review (Arend et al, 1995, Belvisi et al, 2013, Chemlal et al, 1996, Francis et al, 1988, Fukushima et al, 2008, Gardiner et al, 2014, Heard et al, 1992, Hirsh et al, 2004, Ikejiri et al, 2019, Jones et al, 2007, Kasahata et al, 2014, Kaufman et al, 1980, Kawakami et al, 2012, Kodra et al, 2016, Kohlmann et al, 2015, Markus and Allison, 1989, Mitsutake et al, 2018, Murao et al, 1997, Nessle et al, 2017, Ohnishi et al, 2015, Oki et al, 2016, Omori et al, 2008, Peterson et al, 1987, Poggenborg et al, 2008, Poyanli et al, 2001, Ribeiro et al, 2013, Suzuki et al, 2013, Turner et al, 1999, Zayed et al, 2019, Zbinden et al, 2012. Thirty-two patients with bacterial meningitis and vertebral osteomyelitis were identified of whom 18 (57%) were male (table 1).…”