Thoracic Spinal Epidural Abscess Caused by Salmonella Typhi -Case Report-

Abstract

A 56-year-old man presented with a rare spinal epidural abscess manifesting as attacks of back pain associated with fever, weight loss, generalized weakness and fatigability, and constipation. He had multiple skin pustules in the last 4 months treated with oral amoxicillin. He had suffered diabetes mellitus for the last 5 years and was insulin dependent. Physical examination found slight paraparesis with sensory loss around the nipple and sphincteric urgency, and diabetic retinopathy. Magnetic resonance imaging showed edematous T2, T3, and T4 vertebral bodies, and narrow enhanced T3-4 disk space with a soft tissue enhanced mass mostly anterior to the spinal cord and indenting the cord. T3-4 costotransversectomy was performed to remove the extradural mass and evacuate the intradiscal material. Histological examination of the bone found osteomyelitis, and culture of the soft tissue showed Salmonella typhi sensitive to ceftriaxone and ciprofloxacin. Intravenous ceftriaxone administration was started, and the patient was discharged after 6 days in good condition. The outcome of spinal epidural abscess is devastating unless recognized and treated early. The present case of spinal epidural abscess in the thoracic spine caused by Salmonella typhi infection illustrates the importance of cultures to assess the drug sensitivity of the specific strain detected and adjusting the treatment accordingly.

Bug on the back: vertebral osteomyelitis secondary to fluoroquinolone resistantSalmonella typhiin an immunocompetent patient

“…Ampicillin, trimethoprim-sulfamethoxazole and third generation cephalosporins, can be used for resistant cases, in children and in those who cannot tolerate fluoroquinolones 4. Hence, it is imperative to assess drug sensitivity and adjust the treatment regimen accordingly 9. Surgical debridement may be necessary for cases with abscess formation, as in our case.…”

“…Until now, fluoroquinolones have been considered the drug of choice for the treatment of enteric fever. However, resistance to this class of antibiotic, especially with S. typhi and S. paratyphi , in south-east Asia, the Middle East and Africa, has become a serious matter of concern 8 9. Ampicillin, trimethoprim-sulfamethoxazole and third generation cephalosporins, can be used for resistant cases, in children and in those who cannot tolerate fluoroquinolones 4.…”

A Case of Refractory Salmonella Spondylodiscitis in an Immunocompetent Patient Treated Via an Extracavitary Approach, Corpectomy and Placement of Expandable Cage

“…Various authors have reported the rare occurrence of salmonella osteomyelitis involving the spine in immunocompetent patients (Ozturk et al, 2006;Santos and Sapico, 1998;Carvell and MacLarnon, 1981;Dolan et al, 1987;Hunt et al, 1996;Hunt, 1965;Le, 1982;Miller et al, 1988;Mnaymneh, 1977;O'Keeffe et al, 1978;Ortiz-Neu et al, 1978;Sapico and Montgomerie, 1979;Schweitzer et al, 1971;Govender et al, 1999;Cottalorda et al, 1997;Abdullah et al, 2008;Acharya and Bhatnagar, 2004;Akagi et al, 1998). From these groups a few have reported surgical intervention (Ozturk et al, 2006;Wu et al, 2004;Hunt et al, 1996;Le, 1982;Mnaymneh, 1977;Abdullah et al, 2008;Acharya and Bhatnagar, 2004;Akagi et al, 1998) for the treatment of the infection (Table 1).…”

“…From these groups a few have reported surgical intervention (Ozturk et al, 2006;Wu et al, 2004;Hunt et al, 1996;Le, 1982;Mnaymneh, 1977;Abdullah et al, 2008;Acharya and Bhatnagar, 2004;Akagi et al, 1998) for the treatment of the infection (Table 1). None of these case reports though, provides a possible explanation for this incidence.…”

Salmonella Osteomyelitis of the Lumbar Spine: An Unusual Presentation in an Immunocompetent Male

“…It is responsible for variety of human illnesses ranging from gastroenteritis, typhoid fever, and bacteremia to the asymptomatic carrier state [2]. Infection of a spinal segment with paravertebral abscess due to Salmonella has been reported to be extremely rare and that too in patients with predisposing factors such as sickle cell anemia, corticosteroid therapy, and malignancies [3,4]. Since the incidence of tubercular infection of the spine is very high in the Indian subcontinent, it leads to a high index of suspicion and institution of empirical treatment for the same.…”