Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 4072-4080
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4072
Spinal epidural abscess due to coinfection of bacteria and tuberculosis: A case report
Choonghyo Kim, Seungkoo Lee, Jiha Kim
Choonghyo Kim, Jiha Kim, Department of Neurosurgery, Kangwon National University School of Medicine, Chuncheon 24341, Gangwon, South Korea
Choonghyo Kim, Jiha Kim, Department of Neurosurgery, Kangwon National University Hospital, Chuncheon 24289, Gangwon, South Korea
Seungkoo Lee, Department of Anatomic Pathology, Kangwon National University School of Medicine, Chuncheon 24341, Gangwon, South Korea
Seungkoo Lee, Department of Anatomic Pathology, Kangwon National University Hospital, Chuncheon 24289, Gangwon, South Korea
Author contributions: Kim C contributed to conception and design of the study, acquisition of data; Lee S analyzed and interpreted the pathological data; Kim J contributed to manuscript drafting and critical revisions related to important intellectual content of the manuscript; all authors issued final approval of the version of the article to be published.
Informed consent statement: The IRB approved a waiver of informed consent because of the retrospective nature, as details are drawn from medical records and radiologic data.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiha Kim, MD, Professor, Department of Neurosurgery, Kangwon National University School of Medicine, 1 Gangwondaehak-gil, Chuncheon 24341, Gangwon, South Korea. dopaa@kangwon.ac.kr
Received: January 16, 2021
Peer-review started: January 16, 2021
First decision: February 11, 2021
Revised: February 23, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: June 6, 2021
Processing time: 118 Days and 7.2 Hours
Abstract
BACKGROUND

Spinal epidural abscess (SEA) is a rare condition that mostly results from infection with either bacteria or tuberculosis. However, coinfection with bacteria and tuberculosis is extremely rare, and it results in delays in diagnosis and antimicrobial treatment causing unfavorable outcomes.

CASE SUMMARY

A 75-year-old female visited the hospital with low back pain, and magnetic resonance imaging (MRI) revealed an SEA at the lumbosacral segment. Staphylococcus hominis and methicillin-resistant Staphylococcus epidermidis were identified from preoperative blood culture and intraoperative abscess culture, respectively. Thus, the patient underwent treatment with vancomycin medication for 9 wk after surgical drainage of the SEA. However, the low back pain recurred 2 wk after vancomycin treatment. MRI revealed an aggravated SEA in the same area in addition to erosive destruction of vertebral bodies. Second surgery was performed for SEA removal and spinal instrumentation. The microbiological study and pathological examination confirmed Mycobacterium tuberculosis as the pathogen concurrent with the bacterial SEA. The patient improved completely after 12 mo of antitubercular medication.

CONCLUSION

We believe that the identification of a certain pathogen in SEAs does not exclude coinfection with other pathogens. Tubercular coinfection should be suspected if an SEA does not improve despite appropriate antibiotics for the identified pathogen.

Keywords: Bacteremia; Coinfection; Epidural abscess; Tuberculosis; Case report

Core Tip: Spinal epidural abscess (SEA) is a rare condition that mostly results from infection with either bacteria or tuberculosis (TB). However, coinfection with bacteria and TB, as in our case, is extremely rare. Because the blood culture and the surgical specimen results supported bacterial infection, we initially neglected the possibility of TB. Only after SEA recurrence did we suspect coinfection with other organisms. Now, we believe that the identification of a certain pathogen in SEAs does not exclude coinfection with other pathogens. Tubercular coinfection should be suspected if an SEA does not improve despite appropriate antibiotics for the identified pathogen.