Triparesis caused by gas-containing extensive epidural abscess secondary to Aeromonas hydrophila infection of a thoracic vertebroplasty: a case report

• Published in: The spine journal 2013-10, Vol.13 (10), p.e9-e14
• Main Authors: Lee, Jun-Seok, MD, Choi, Su-Mi, MD, Kim, Ki-Won, MD
• Format: Article
• Language: English
• Subjects: Aeromonas hydrophila; Aged; Anti-Bacterial Agents - therapeutic use; Decompression, Surgical; Epidural abscess; Epidural Abscess - microbiology; Epidural Abscess - therapy; Gas formation; Gram-Negative Bacterial Infections - complications; Gram-Negative Bacterial Infections - therapy; Humans; Male; Orthopedics; Paresis - microbiology; Postoperative Complications - microbiology; Postoperative Complications - therapy; Spinal Fractures - surgery; Spondylitis; Thoracic Vertebrae; Vertebroplasty; Vertebroplasty - adverse effects
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2013.03.045

Abstract Background context Aeromonas hydrophila is a motile gram-negative non-sporeforming rod with facultative anaerobic metabolism. Except for gastrointestinal disease, skin and soft-tissue infections represent the second most common site of human Aeromonas infections. However, to our knowledge, A. hydrophila infection of the spine has not been reported to date. Purpose To report the first case of A. hydrophila spinal infection of the T7 vertebra after vertebroplasty. Study design Case report. Methods A 72-year-old man was transferred to our emergency department with chief complaints of severe midthoracic pain and triparesis. He had undergone vertebroplasty for a painful vertebral fracture at T7 5 weeks before transfer. Magnetic resonance imaging showed an infection of the T7 vertebroplasty and an extensive epidural abscess. The epidural abscess originating from the infected T7 vertebroplasty extended from the T8 to the C4 epidural space. Computed tomography demonstrated sparsely scattered gas in the epidural abscess, strongly suggestive of an anaerobic infection. Results Emergency multilevel laminectomies from C5 to T8 and a posterior instrumentation from T3 to T10 were performed. A. hydrophila was isolated from the blood cultures. The patient was treated with intravenous ampicillin/sulbactam. Posterior decompression and stabilization in combination with appropriate antibiotic treatment completely resolved the neurologic deficit and infection without the need for further anterior corpectomy of the infected T7 vertebroplasty. Conclusions This is the first reported case of spine infection caused by A. hydrophila. The infection developed after vertebroplasty for the management of a painful vertebral fracture. Triparesis occurred rapidly due to an extensive epidural abscess containing gas. Emergency decompression and stabilization in combination with appropriate antibiotic treatment achieved a successful clinical outcome.