Fatal Cervical Spinal Epidural Abscess and Spondylodiscitis Complicated With Rhombencephalitis Caused by Klebsiella pneumoniae: A Case Report and Literature Review

Abstract

Spinal epidural abscess (SEA) is a rare but sometimes life-threatening condition. The principal organisms in SEA and spondylodiscitis are gram-positive bacteria, e.g., Staphylococcus aureus and Streptococci. Spontaneous gram-negative SEA and spondylodiscitis especially Klebsiella pneumoniae are very rare. We report a 71-year-old Thai male with diabetes, presenting fever, enlarged neck mass, and progressive painful swallowing a week before admission. MRI of the whole spine demonstrated epidural abscess along the anterior thecal sac from C2 to C7 levels with spinal meningitis; multiple rim-enhancing lesions at the left sternocleidomastoid/levator scapulae, splenius capitis, semispinalis capitis, and bilateral scalene muscles; and rhombencephalitis with brain abscess. Klebsiella pneumoniae was isolated from blood culture. CT of the whole abdomen showed unremarkable intra-abdominal lesion. Intravenous ceftriaxone was administered, but the patient was unable to undergo surgical drainage due to unstable condition and died after two weeks of admission. Spontaneous SEA and spondylodiscitis caused by K. pneumoniae are very rare but sometimes fatal. In the case of SEA and spondylodiscitis, even when K. pneumoniae is uncommon, it should be also considered as a pathogen, especially when the patient had important risk factors.

Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review

“…The supratrochlear lymph nodes will eventually drain into the axillary lymph nodes, which will then travel to the heart through the thoracic duct, and may subsequently access the Batson plexus. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57…”

Pyogenic spondylodiscitis in HIV-positive patients under antiretroviral therapy: A case series

“…21 In our patient the infection was spontaneous, which has recently also been described in a Japanese and a Thai male. 22,23 Bacterial translocation across the intestinal mucosa has been suggested as possible entry mechanism. Sexual practices with anal intercourse (and possibly concomitant drug use) could have played a role in our patient, as he also acquired hepatitis C during this time.…”

Uncommon Culprit, Familiar Foe: A Case of Septic Thrombophlebitis of the Internal Jugular Vein Triggered by Klebsiella Bacteremia

“…Catheters may be the source for the introduction of bacteria that leads to thrombosis and infection. This is distinct from infection typically arising from the oral intestinal mucosa known as Lemierre syndrome, which has an incidence of approximately 3.6 cases per million individuals [3]. Fusobacterium necrophorum has been well-established as the classical pathogen associated with Lemierre syndrome [4].…”