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Abstract
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Introduction
Spinal epidural abscess, a collection of pus or inflammation between the thecal sac and surrounding tissue, is a rare condition in healthy adult patients, known for an incidence of 2.4 cases per 100 000 persons. Around half of the cases are due to a haematogenous spread, and almost a third because of a discitis spread. The most frequent microorganism is Staphylococcus aureus for 50 to 65% of cases, followed by gram negative bacilli such as Escherichia coli (18%) and Pseudomonas species in intravenous (IV) drug users. Usually seen in adults aged more than 60 years, risk factors include : immunodeficiency, HIV infection, malignancy, immunosuppressive treatments and IV drug abuse. Adequate timely diagnosis of spinal epidural abscess is crucial because around one fourth of patients may develop motor deficit or paralysis. We describe here the case of a healthy patient who presented a lumbar spinal epidural abscess related to a dental infection, without any risk factor.
Methods
A 57 year-old immunocompetent male patient presented himself to our emergency department because of a ten-day duration lumbar pain, after a lumbar torsion. He was neurologically intact, but showed a biological inflammatory syndrome. A lumbar MRI found a spinal epidural abscess from L3-L4 to L5-S1 levels. The patient was operated early before occurrence of neurological deficit. The abscess cultures found a Streptococcus mitis infection.
Results
The patient presented good recovery after surgical decompression, washout with samples and targeted antibiotic therapy for six weeks.
Conclusion
In the present case, we think that, considering a pain-free period before the lumbar torsion of the patient, an insidious onset of L5-S1 spondylodiscitis related to Streptococcus mitis spreading from a dental cary may have been decompensated during the torsion and have released bacteria around the dura mater, leading to abscess formation. The final collapse of the L5-S1 disc on lumbar MRI at the 6-week follow up argued in favour of this hypothesis.
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