J Korean Orthop Assoc.  2017 Aug;52(4):359-363. 10.4055/jkoa.2017.52.4.359.

Serratia marcescens Spinal Epidural Abscess Following Caudal Epidural Injection

Affiliations
  • 1Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Korea. docby@hanmail.net

Abstract

Spinal infection due to Serratia marcescens is very rare. A 78-year-old male patient withoutany risk factor was admitted to our hospital with chief complaints of severe back pain, fever, weakness in both legs, and bowel dysfunction, following caudal epidural injection. Magnetic resonance imaging revealed spondylodiscitis with epidural abscess. Surgical decompression was performed and the epidural abscess was removed. The cultures isolated S. marcescens, which can cause nosocomial infection in immunocompromised patient. However, to the best of our knowledge, we report the first case of S. marcescens spinal epidural abscess following epidural injection, with literature review.

Keyword

spinal epidural abscess; epidural injection; Serratia marcescens

MeSH Terms

Aged
Back Pain
Cross Infection
Decompression, Surgical
Discitis
Epidural Abscess*
Fever
Humans
Immunocompromised Host
Injections, Epidural*
Leg
Magnetic Resonance Imaging
Male
Risk Factors
Serratia marcescens*
Serratia*

Figure

  • Figure 1 T2-weighted magnetic resonance sagittal image (A) and axial images (B, C) showing abscess located in the posterior epidural space at the L2–3 level and anterior epidural space at the L4 level.

  • Figure 2 T1-weighted gadoliniumenhanced axial images at the L2–3 (A) and L4–5 intervertebral disc level (B) show an abscess with rim-enhancement compressing the dural sac.

  • Figure 3 Red pigmentation of Serratia marcescens discharged from wound blood-red (A) compared with other usual open wounds (B).


Reference

1. Kim SK, Chung JY. Epidural steroid injection. J Korean Med Assoc. 2014; 57:318–25.
Article
2. Rigamonti D, Liem L, Sampath P. . Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. 1999; 52:189–96.
Article
3. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006; 355:2012–20.
Article
4. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000; 23:175–204. discussion 205.
Article
5. Soehle M, Wallenfang T. Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery. 2002; 51:79–85. discussion 86, 7.
Article
6. Hadjipavlou AG, Gaitanis IN, Papadopoulos CA, Katonis PG, Kontakis GM. Serratia spondylodiscitis after elective lumbar spine surgery: a report of two cases. Spine (Phila Pa 1976). 2002; 27:E507–12.
7. Alfonso Olmos M, Silva González A, Duart Clemente J, Villas Tomé C. Infected vertebroplasty due to uncommon bacteria solved surgically: a rare and threatening life complication of a common procedure: report of a case and a review of the literature. Spine (Phila Pa 1976). 2006; 31:E770–3.
8. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord. 2000; 13:422–6.
Article
9. Perez-Toro MR, Burton AW, Hamid B, Koyyalagunta D. Two-tuohy needle and catheter technique for fluoroscopically guided percutaneous drainage of spinal epidural abscess: a case report. Pain Med. 2009; 10:501–5.
Article
10. Huang CR, Lu CH, Chien CC, Chang WN. Protean infectious types and frequent association with neurosurgical procedures in adult Serratia marcescens CNS infections: report of two cases and review of the literature. Clin Neurol Neurosurg. 2001; 103:171–4.
Article
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