Spinal epidural abscess: Esophageal fistula as a potential infection source

We present a case report of a man with a history of esophageal cancer who presented with fever, pain, and lower extremity weakness. The patient previously underwent chemotherapy, radiation, and immunotherapy treatment. He also underwent esophageal dilation, stent placement, and removal. MRI scans of...

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Bibliographic Details
Published in:Interdisciplinary neurosurgery : Advanced techniques and case management 2019-06, Vol.16, p.42-43
Main Authors: Herrmann, Amanda A., Othman, Sally I., DeFoe, Kathryn M., Carolan, Eric J., Rosenbloom, Michael H.
Format: Article
Language:English
Subjects:
Bacterial infections
Clinical neurology history
Epidural abscess
Esophageal fistula
Spinal cord infection
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Summary:We present a case report of a man with a history of esophageal cancer who presented with fever, pain, and lower extremity weakness. The patient previously underwent chemotherapy, radiation, and immunotherapy treatment. He also underwent esophageal dilation, stent placement, and removal. MRI scans of the spine revealed a longitudinal spinal epidural abscess (SEA) resulting in compressive myelopathy. The suspected infection cause was gastrointestinal-associated Gram-negative rods tracking to the epidural space from an esophageal fistula. This case demonstrates the importance of early diagnosis and treatment and the role of fistula as an infection source in SEA. •In rare cases, a potential cause of spinal epidural abscess could be the result of an esophageal fistula.•Not every patient will present with the classic triad of symptoms of SEA (fever, back pain, and neurological deficit).•Early diagnosis and treatment in SEA is critical to prevent morbidity and mortality.
ISSN:2214-7519
2214-7519
DOI:10.1016/j.inat.2018.12.007