J Korean Soc Spine Surg.  2017 Dec;24(4):236-240. 10.4184/jkss.2017.24.4.236.

Abscess of the Cervical Spine Caused by Klebsiella Peumoniae with Acute Compressive Flexion Injury: A Case Report

• Kim MW
• Lee KY

• KMID: 2408192
• DOI: http://doi.org/10.4184/jkss.2017.24.4.236

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To report an unusual case of an abscess of the cervical spine caused byKlebsiella peumoniae accompanied by an acute compressive flexion injury. SUMMARY OF LITERATURE REVIEW: Spondylitis caused by Klebsiella peumoniae is very rare, and an unrecognized epidural abscess complicated with spinal cord compression can lead to severe neurologic deficits.
MATERIALS AND METHODS
A 66-year-old male patient diagnosed with a liver abscess caused by Klebsiella peumoniae was referred from the internal medicine department to our department due to abrupt posterior neck pain and limitation of motion after a fall from the bed. He showed persistent fever and progressive dysphagia. We diagnosed the condition as a massive cervical abscess caused by Klebsiella peumoniae accompanied by an acute compressive flexion injury. We performed drainage of the massive abscess, anterior fusion to treat the loss of the intervertebral discs at the C3/4 level, and corpectomy for a compression fracture of the C6 vertebral body using a cage and plate via an anterior approach. Subsequently, we performed posterior laminectomy with drainage at the C3-6 level and posterior instrumentation of C2-7 via a posterior approach.
RESULTS
Starting on the second postoperative day, the patient showed a decreased fever and gradual restoration of muscle strength and function in the upper extremities and hands.
CONCLUSIONS
Klebsiella peumoniae may cause spinal infection as an opportunistic infection in patients with impaired immune function, and cervical infections in particular require aggressive early treatment because serious neurological symptoms may occur, even in cases of minor trauma.

Keyword

Spondylitis; Spinal injuries; Klebsiella peumoniae

MeSH Terms

Abscess*
Aged
Deglutition Disorders
Drainage
Epidural Abscess
Fever
Fractures, Compression
Hand
Humans
Internal Medicine
Intervertebral Disc
Klebsiella*
Laminectomy
Liver Abscess
Male
Muscle Strength
Neck Pain
Neurologic Manifestations
Opportunistic Infections
Spinal Cord Compression
Spinal Injuries
Spine*
Spondylitis
Upper Extremity

Figure

• 

  Fig. 1. Enhanced abdominal computed tomography shows a large immature hepatic abscess and multiple small abscesses.

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  Fig. 2. Anteroposterior (A) and lateral (B) views of the cervical spine show soft tissue thickening (dotted line) on the anterior aspect of the cervical spine with osteolysis of C4. A compression fracture of the C6 vertebral body is seen, with a widened interspinous space at C5-6 (arrow).

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  Fig. 3. A cervical T2-weighted sagittal magnetic resonance (MR) image shows a massive abscess collection (A). Cervical axial T2-weighted MR images show the spinal canal compressed by the abscess at C3-4 (B). High signal enhancement of the C5-6 interspinous ligament was seen on a T2 fat-suppression sagittal MR image (C). Axial computed tomography image shows a comminuted compression fracture at C6 (D).

• 

  Fig. 4. Anteroposterior (A) and lateral (B) views at 4 months after the operation.

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