• World Neurosurg · Dec 2023

    Case Reports

    Spinal Epidural Abscess and Strep Pharyngitis.

    • Phoebe Greenwald and Andrew K Chan.
    • Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA. Electronic address: Plg2117@cumc.columbia.edu.
    • World Neurosurg. 2023 Dec 1; 180: 777877-78.

    AbstractSpinal epidural abscesses (SEA) require prompt diagnosis to avoid devastating consequences. Here, we discuss the case of a healthy 20-year-old college student-with a recent diagnosis of strep pharyngitis-who presented with neck pain, fever, and a neurologic deficit-the most common symptoms of SEA. Magnetic resonance imaging revealed a T1-postcontrast, peripherally enhancing epidural collection from C3-T5 with associated cord compression and T3 osteomyelitis. The patient was treated with emergent skip hemilaminectomies for abscess evacuation. Surgical cultures grew Fusobacterium necrophorum, a highly unusual pathogen in SEA. It is an oral anaerobe that translocated through the mucosa in the setting of strep pharyngitis. We treated the patient with ceftriaxone for 6 weeks. The patient had a full neurologic recovery and remains without recurrence of infection 11 months postoperatively. Healthy patients without obvious risk factors may present with SEA, highlighting the need for atypical cases such as these to be brought to clinicians' attention.Copyright © 2023 Elsevier Inc. All rights reserved.

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