Neisseria gonorrhoeae paravertebral abscess

Abstract

<jats:p>The authors present the case of an isolated gonococcal paravertebral abscess with an epidural component in a 42-year-old man. A primary epidural abscess of the spine is a rare condition and is most commonly caused by<jats:italic>Staphylococcus aureus</jats:italic>. In this report, the authors present their therapeutic decisions and review the relevant literature on disseminated gonococcal infection in a patient presenting with an epidural abscess.</jats:p><jats:p>A 42-year-old Indonesian man was admitted with symptoms of neck and upper back pain and bilateral lower-limb weakness. Clinical examination was unremarkable apart from tenderness over the lower cervical spine. Postgadolinium T1-weighted MRI of the cervical and thoracic spine demonstrated an enhancing lesion in the right paraspinal and epidural soft tissue at C-6 to T1–2, in keeping with a spinal epidural abscess. The patient underwent laminectomy of C-7 and T-1 with abscess drainage. Tissue cultures subsequently grew<jats:italic>Neisseria gonorrhoeae</jats:italic>that was resistant to quinolones by genotyping. Upon further questioning, the patient admitted to unprotected sexual intercourse with commercial sex workers. Further investigations showed that he was negative for other sexually transmitted infections. Postoperatively, he received a course of beta-lactam antibiotics with good recovery. Clinicians should be aware of this unusual disseminated gonococcal infection manifested in any patient with the relevant risk factors.</jats:p>

A Rare Case of Disseminated Pyogenic Gonococcal Infection in an Immunocompetent Woman

“…On the other hand, although azithromycin was resistant in vitro, it was included in the therapeutic regimen at least for a potential broader and enhanced activity given the rapid evolution of the clinical condition. Septic arthritis is a well-characterized late complication of the bacteremic stage of the disease; the spinal vertebrae however become affected very rarely [5]. Our patient may have developed this complication due to preexisting degenerative lesions of the spine and the adjacent inflammatory fluid collection that developed in the course of the disease.…”

“…There are only few published cases of disseminated pyogenic gonococcal infection either as spondylitis [5] or as pyomyositis [10]. …”

“…In 1976, Seruzier et al published probably the first case of gonococcal spinal infection in a 47-year-old male with spondylodiscitis at the level of 9th and 10th thoracic vertebra [17]. In 2004, Van Hal and Post reported a thoracic epidural mass at 6th to 7th vertebra [18] and more recently Low et al reported a case of gonococcal spinal epidural abscess extended from the 6th cervical to the 2nd thoracic vertebra without cord compression [5]. …”

Septic arthritis in immunocompetent and immunosuppressed hosts

“…N. gonorrhoeae septic arthritis is suspected when a patient is young and sexually active; when there is associated tenosynovitis or vesicular pustules on the skin; or when the patient has a late complement deficiency. Although, historically, N. gonorrhoeae primarily affects the knee [22], there have been reports of N. gonorrhoeae infections of the axial skeleton as well [23].…”

Response to: ‘Short duration antibiotic therapy for native joint arthritis cause byNeisseriainfection?’ by Durcourset al

“…1 This is important, because long parenteral antibiotic therapies (eg, 4 weeks) are still being reported for neisserial infections. 8 We therefore congratulate our colleagues for their study and encourage other researchers to perform prospective trials aiming at the optimisation of systemic antibiotic treatment for adult native joint septic arthritis.…”