Cervical Spinal Epidural Abscess Due to Mycobacterium tuberculosis without Osseous Involvement

Catarino, Isabel; Robles, Diogo; Lopes, Daniel; Silva, Fernando; Sousa, Carlos de

doi:10.2106/jbjs.cc.15.00287

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…A literature review of Mycobacterium causing an epidural collection discloses a number of studies reporting both typical ( M. tuberculosis, M. bovis, and M. leprae ) and atypical ( M. abscessus, M. avium-intracellulare, and M. fortuitum ) Mycobacterium causing epidural abscesses. In some cases, the epidural abscess extended into neighboring bone, intervertebral disc, and paraspinal and psoas musculature [ 10 , 13 , 14 ], while in others, adjacent osseous and soft tissue structures were not reported to be involved [ 15 - 17 ]. As mentioned in Introduction, only one other case of an isolated M. abscessus epidural abscess has been reported.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Bashti¹,

Kumar²,

Côté³

et al. 2023

Cureus

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Epidural abscesses can be caused by a number of different organisms, including atypical Mycobacterium. This is a rare case report of an atypical Mycobacterium epidural abscess requiring surgical decompression. Here, we present Mycobacterium abscessus causing a nonpurulent epidural collection surgically treated with laminectomy and washout and discuss clinical clues and radiologic characteristics associated with this condition.A 51-year-old male with a past medical history of chronic intravenous (IV) drug use presented with a threeday history of falls and three-month history of progressively worsening bilateral lower extremity radiculopathy, paresthesias, and numbness. MRI demonstrated an enhancing collection at L2-3 ventral and to the left of the spinal canal causing severe compression of the thecal sac, along with heterogenous contrast enhancement of the L2-3 vertebral bodies and intervertebral disc. The patient was taken for an L2-3 laminectomy and left medial facetectomy, where a fibrous, nonpurulent mass was discovered. Cultures ultimately demonstrated Mycobacterium abscessus subspecies massiliense, and the patient was discharged on IV levofloxacin, azithromycin, and linezolid with complete symptomatic relief.Unfortunately, despite surgical washout and antibiotic coverage, the patient presented twice more, the first time with a recurrent epidural collection requiring repeat drainage and the second time with a recurrent epidural collection with discitis and osteomyelitis with pars fractures requiring repeat epidural drainage and interbody fusion.It is important to recognize that atypical Mycobacterium abscessus can cause a nonpurulent epidural collection, especially in high-risk patients such as those with a history of chronic IV drug use. Additionally, our initial intraoperative findings of a fibrous, adherent mass suggest that in cases where this entity is suspected, surgical decompression should be carefully considered. To this end, the radiologic findings associated with this condition, namely, an enhancing ventral epidural mass involving the disc space, should also be recognized. The notable postoperative course consisting of recurrent collections and osteomyelitis with a pars fracture suggests that early fusion should be considered as an option in these patients. This case report presents clinical and radiologic findings associated with an atypical Mycobacterium discitis and osteomyelitis. The clinical course described herein suggests that early fusion in these patients may provide superior results to decompression alone.

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Section: Discussionmentioning

confidence: 99%

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Bashti¹,

Kumar²,

Côté³

et al. 2023

Cureus

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“…An epidural abscess is an even rarer complication of disseminated MAI [ 3 ]. It has been previously documented in M. tuberculosis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Disseminated Mycobacterium avium intracellulare Presenting as Spondylodiscitis and Epidural Abscess in a Patient with Acquired Immune Deficiency Syndrome (AIDS)

et al. 2021

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Patient: Male, 65-year-old Final Diagnosis: Mycobacterium avium intracellulare epidural abscess Symptoms: Back pain • flank pain Medication: — Clinical Procedure: Debridement • evacuation of epidural abscess • laminectomy Specialty: Infectious Diseases • Neurosurgery Objective: Unusual clinical course Background: Mycobacterium avium intracellulare complex (MAI) is a member of the non-tuberculous mycobacteria family, which can cause both pulmonary and non-pulmonary disease. In patients with advanced HIV, it is known to cause disseminated disease. We present a case of a 65-year-old man who has sex with men (MSM) with AIDS, found to have spondylodiscitis and an epidural abscess, who had recently completed treatment for disseminated MAI. Case Report: The patient was a 65-year-old with AIDS secondary to HIV and a prior history of disseminated MAI, who presented with severe back pain. Upon presentation to the hospital, an MRI was performed, which was suggestive of spondylodiscitis and an epidural abscess. He was taken to surgery for a minimally invasive T12-L1 laminectomy and evacuation of the epidural abscess. Both traditional cultures and acid-fast bacillus (AFB) cultures were negative. Due to worsening pain, he was taken back to surgery for a repeat debridement and biopsy. Repeat cultures were positive for MAI. He was started on rifabutin, ethambutol, azithromycin, and moxifloxacin. Moxifloxacin was subsequently discontinued. He has had problems tolerating the treatment regimen, but is planned to complete an 18–24-month course. Conclusions: For patients with AIDS who have a diagnosis of spondylodiscitis and an epidural abscess, an opportunistic infection such as MAI should be considered. A repeat biopsy should be considered if suspicion is still high, even despite initially negative cultures. Treatment regimens should be prolonged, despite difficulty with medication compliance.

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Giant cell tumor of bone: imaging and histology changes after denosumab treatment

2017

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Cervical Spinal Epidural Abscess Due to Mycobacterium tuberculosis without Osseous Involvement

Cited by 5 publications

References 15 publications

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Recurrence of Disseminated Mycobacterium avium intracellulare Presenting as Spondylodiscitis and Epidural Abscess in a Patient with Acquired Immune Deficiency Syndrome (AIDS)

Giant cell tumor of bone: imaging and histology changes after denosumab treatment

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