J Korean Orthop Assoc.  2011 Dec;46(6):528-532.

Spondylodiscitis with Epidural Abscess Caused by Klebsiella pneumoniae

• Cho CH
• Min WK
• Park BC

Abstract

Spondylodiscitis is very rare complication caused by Klebsiella pneumoniae. Among those, few cases of spondylodiscitis concomitant with epidural abscess due to Klebsiella pneumoniae have been reported. We present a case of lumbar pyogenic spondylodiscitis with epidural abscess caused by Klebsiella pneumoniae that successfully treated with administration of cefotaxime, surgical drainage and intermittent closed continuous saline irrigation.

Keyword

spondylodiscitis; spondylitis; epidural abscess; Klebsiella pneumoniae

MeSH Terms

Cefotaxime
Discitis
Drainage
Epidural Abscess
Klebsiella
Klebsiella pneumoniae
Spondylitis
Cefotaxime

Figure

• 

  Figure 1 (A) Epidural abscess at L2-3 level on sagittal T2 weighted images, which compresses the dura of lumbar spine. Abnormal intensity of L2-3 interverteral disc space was seen. (B) Epidural abscess and the destruction of intervertebral disc at the L2-3 level and Psoas abscess at L3-4 level on axial T2 weighted images. (C) Epidural abscess and the destruction of intervertebral disc at the L2-3 level and Psoas abscess at L3-4 level on axial Gadolinium enhancement images.

• 

  Figure 2 After the sudden onset of neurologic symptom, emergency follow-up magnetic resonance imaging revealed the increase of epidural abscess at L2-4 level.

• 

  Figure 3 Draining tube through L2-3 epidural space was seen on the sagittal T2 weighted (A) and the Gadolinium enhanced magnetic resonance imaging (B) 3 days after surgery.

Reference

1. Chevalier X, Marty M, Larget-Piet B. Klebsiella pneumoniae septic arthritis of a lumbar facet joint. J Rheumatol. 1992. 19:1817–1819.

2. Torda AJ, Gottlieb T, Bradbury R. Pyogenic vertebral osteomyelitis: analysis of 20 cases and review. Clin Infect Dis. 1995. 20:320–328.

3. Vorbeck F, Morscher M, Ba-Ssalamah A, Imhof H. Infectious spondylitis in adults. Radiologe. 1996. 36:795–804.

4. Kouroussis C, Georgoulias V, Souglakos J, Simvoulakis E, Karabekios S, Samonis G. Spontaneous spondylodiscitis caused by Klebsiella pneumoniae. Infection. 1999. 27:368–369.

5. Porras JA, Bayona C, Gutiérrez MC, Vidal F. Vertebral osteomyelitis due to Klebsiella pneumoniae. An Med Interna. 1994. 11:154–155.

6. Apple JS, Halvorsen RA, Chapman TM, Martinez S. Klebsiella pneumoniae arthritis of the hip in a diabetic patient. South Med J. 1984. 77:229–231.

7. DelCurling O Jr, Gower DJ, McWhorter JM. Changing concepts in spinal epidural abscess: a report of 29 cases. Neurosurgery. 1990. 27:185–192.

8. Yacoub WN, Sohn HJ, Chan S, Petrosyan M, Vermaire HM, Kelso RL, et al. Psoas abscess rarely requires surgical intervention. Am J Surg. 2008. 196:223–227.

9. Ohara N, Tominaga O, Uchiyama M, Nakano H, Muto T. Primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. J Orthop Sci. 1998. 3:221–224.

10. Tofuku K, Koga H, Yone K, Komiya S. Continuous irrigation in pyogenic spondylitis accompanied by iliopsoas abscess. Spine (Phila Pa 1976). 2007. 32:E382–E387.