Abstract

Introduction: Group B streptococcal (GBS) spinal epidural abscesses are rarely reported. This most commonly occurs through hematogenous spread. The most common microbe causing a spinal epidural abscess is Staphylococcus aureus. Abscesses in the spine can compress the spinal cord and cause irreversible damage if not treated promptly. To increase awareness, we report a case of a 36-year-old female with a GBS spinal epidural abscess and describe its clinical course, disease features, and treatment. Case description: 36-year-old female with PMH of IDDM, bipolar disorder, schizoaffective disorder, and polysubstance use disorder. Presented to the ED with chief complaints of back and bilateral leg pain. Patient had similar presenting symptoms at a previous admission but decided to leave AMA prior to further evaluation. On current admission, patient was admitted to the ICU with concerns of DKA. Patient was found to be meeting SIRS criteria; however, no source of infection was identified. Patient was also found to be experiencing urinary retention. A thorough history revealed that patient had a history of IV drug use with needle sharing. Blood cultures returned positive for GBS. A TTE revealed an LVEF of 51% with mild mitral regurgitation, however no evidence of vegetation. Given patient’s presentation of lower back pain and point tenderness along patient’s thoracic spine, pan-imaging of patient’s spine was ordered to rule out osteomyelitis. MRI revealed Osteomyelitis at L5-S1 but also a multiloculated abscess of the right paraspinal muscles spanning from L3 through the mid-sacral region. An ascending epidural abscess was noted dorsally extending into the cervical spine region, extending from the thoracic spine to the C2 spinous process. This was causing displacement of the cord and dura ventrally and flattening of the cord causing severe spinal canal narrowing. Patient required emergent evaluation by neurosurgery. Conclusion: With the prevalence of back pain in the United States, it is essential to have proper and broad initial differentials of rare presentations so that diseases can be properly identified and promptly addressed. Diagnosing spinal epidural abscesses is rare and fatal if not treated early, so identification is vital to reducing mortality and future neurological deficits.

References

Chung SY, Chen CH, Yu WL. Spinal epidural abscess caused by group B Streptococcus in a diabetic woman presenting with febrile low back pain. Jpn J Infect Dis. 2005 Jun;58(3):177-9. PMID: 15973012.

Grant Jenkin, Ian J. Woolley, Graham V. Brown, Michael J. Richards, Postpartum Epidural Abscess Due to Group B Streptococcus, Clinical Infectious Diseases, Volume 25, Issue 5, November 1997, Page 1249, https://doi.org/10.1086/516961

Bureta C, Tominaga H, Yamamoto T, Setoguchi T, Kawamura H, Nagano S, Kawamura I, Abematsu M, Kakoi H, Ishidou Y, Komiya S. Lumbar spine epidural abscess and facet joint septic arthritis due to Streptococcus agalactiae: a case report. BMC Surg. 2018 Mar 13;18(1):16. doi: 10.1186/s12893-018-0350-2. PMID: 29534714; PMCID: PMC5851089.

Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, et al. EPidemiology of invasive group b streptococcal disease in the United States, 1999-2005. JAMA, 2008;299(17):2056–65. 10.1001/jama.299.17.2056.

Farley MM, Strasbaugh LJ. Group B streptococcal disease in nonpregnant adults. Clin Infect Dis. 2001;33(4):556–561. doi: 10.1086/322696.

Davis DP, Wold RM, Patel RJ, Tran AJ, Tokhi RN, Chan TC, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004;26(3):285–291. doi: 10.1016/j.jemermed.2003.11.013

Reihsaus, E., Waldbaur, H. & Seeling, W. Spinal epidural abscess: a meta-analysis of 915 patients.Neurosurg Rev 23, 175–204 (2000). https://doi.org/10.1007/PL00011954