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Vol. 153. Issue 7.
Pages 290-292 (October 2019)
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Vol. 153. Issue 7.
Pages 290-292 (October 2019)
Clinical report
DOI: 10.1016/j.medcle.2019.06.014
Spinal epidural abscess caused by Streptococcus agalactiae in an immunocompetent patient
Absceso epidural espinal por Streptococcus agalactiae en un paciente inmunocompetente
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Marta Vales Monteroa,
Corresponding author
martavamon@hotmail.com

Corresponding author.
, Olga Mateo Sierrab, Julia Romero Martínezc, Fernando Fortea Gilc, Carlos Fernández Carballalb, Juan Pablo Cuelloa
a Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Abstract
Background

Streptococcus agalactiae is an uncommon microorganism that causes spinal epidural abscess (SEA) and usually affects individuals with a predisposing condition or potential source of infection.

Case description

We present the case of an immunocompetent 53-year-old patient with an unremarkable past medical history who developed progressive low extremity weakness, bowel and bladder dysfunction and genital sensory impairment. A neurological exam on admission revealed flaccid proximal paraparesis, T10 sensory level, atonic anal sphincter and normal myotatic reflexes. Urgent neuroimaging showed a large thoracic epidural spinal abscess. Laminectomy and abscess drainage were immediately performed and systemic antibiotic treatment was initiated. Abscess cultures revealed S. agalactiae. After an exhaustive workup no predisposing factors or local or systemic source for the infection were found after a one-year follow-up and rehabilitation the patient achieved a satisfactory neurological outcome.

Conclusions

We report a singular case of spinal epidural abscess caused by S. agalactiae in a healthy patient with no predisposing factors. This case also highlights the importance of an early diagnosis and treatment to obtain a better neurological outcome.

Keywords:
Spinal epidural abscess
Spinal infection
Immunocompetent
Spinal cord
Streptococcus agalactiae
Laminectomy
Resumen
Introducción

Streptococcus agalactiae es un microorganismo causal infrecuente en el absceso epidural espinal (AEE) que generalmente afecta a pacientes con comorbilidades predisponentes y/o alguna potencial fuente de infección.

Caso clínico

Presentamos el caso de un paciente de 53 años, inmunocompetente y sin antecedentes médicos de interés, que desarrolló un cuadro de dolor lumbar, paraparesia y disfunción de esfínteres en el contexto de un síndrome febril sin foco conocido de una semana de evolución. La exploración neurológica mostró paraparesia flácida proximal, nivel sensitivo T10, esfínter anal atónico y reflejos osteotendinosos normales. Una RM medular mostró un extenso absceso epidural espinal dorsal. Se realizó una laminectomía urgente con drenaje del absceso en menos de 24 horas y se inició antibioterapia empírica. El resultado del cultivo mostró Streptococcus agalactiae. Tras un estudio exhaustivo, no se encontró ninguna enfermedad predisponente ni fuente de la infección.

Conclusiones

Describimos un caso infrecuente de AEE causado porStreoptococcus agalactiae en un paciente sano sin factores predisponentes. Este caso subraya la importancia del diagnóstico precoz de esta entidad, dado que se puede asociar potencialmente con un mejor pronóstico.

Palabras clave:
Absceso epidural espinal
Infección espinal
Inmunocompetente
Médula espinal
Streptococcus agalactiae
Laminectomía

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