J Korean Soc Spine Surg.  2016 Dec;23(4):234-238. 10.4184/jkss.2016.23.4.234.

The Co-occurance of Meningitis and Para-spinal Infection after Repetitive Procedural Treatment of the Spine: A Case Report

• Mun JU
• Lee SJ

• KMID: 2365084
• DOI: http://doi.org/10.4184/jkss.2016.23.4.234

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
We report a case of meningitis combined with paraspinal infection in a patients who underwent numerous surgeries for and repetitive procedural treatment of the spine. SUMMARY OF LITERATURE REVIEW: In patients with a history surgical and repetitive procedural treatment of the spine, one symptom of infection may be a fever with localized pain or tenderness along the spine.
MATERIALS AND METHODS
A 69-year-old man was hospitalized due to pyrexia and myalgia. Eight years ago, he underwented spine surgery. After that, the patient underwent spinal intervention more than once per week in another hospital due to remaining pain. One week before his visit to the emergency room, myalgia and aggravation in the lower back arose. However, a paraspinal infection was not detected in a non-enhanced MRI. One day after admission, the patient showed signs of meningeal irritation signs and the the patient's mental state suddenly deteriorated. An emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. An enhanced MRI of the brain showed pachymeningeal enhancement. An enhanced MRI of the spine showed a small abscess formation on the left paravertebral back muscle, and bilateral psoas muscle.
RESULTS
Serrtia marcescens was identified on blood cultures obtained upon admission. Since antibiotics were used to treat Serratia marcescens, the fever subsided, and the patient's mental status returned to normal.
CONCLUSIONS
For patients with a history of repetitive procedural treatments of the spine, a fever should be acknowledged as a symptom in meningitis or other infectious conditions.

Keyword

Paraspinal infection; Meningitis

MeSH Terms

Abscess
Aged
Anti-Bacterial Agents
Back Muscles
Brain
Cerebrospinal Fluid
Emergencies
Emergency Service, Hospital
Fever
Humans
Magnetic Resonance Imaging
Meningitis*
Meningitis, Bacterial
Myalgia
Psoas Muscles
Serratia marcescens
Spine*
Anti-Bacterial Agents

Figure

• 

  Fig. 1. Magnetic resonance image from another hospital did not reveal paraspineal infection, or the epidural abscess. (A) T2 weighted saggital image. (B) T2 weighted axial image at the L4/5 level.

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  Fig. 2. Enhanced magnetic resonance imaging (MRI) of the spine and the brain. (A) T1 weighted enhanced saggital image. (B) T1 axial axial image at the level of the L4/5, showed small abscess formation of the left paravertebral back muscle and the bilateral psoas muscle. (C) Axial brain MRI showed pachymeningeal enhancement.

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