Rare instance of a spinal epidural abscess caused by Staphylococcus epidermidis in a young person: Providing clinical lessons and considerations for diagnosis
A rare case of a spinal epidural abscess (SEA) in a 14-year-old male, caused by Staphylococcus epidermidis (S. epidermidis), has been reported. This case, which involved no typical risk factors, highlights the potential for S. epidermidis to cause SEAs, particularly in the context of medical procedures or devices.
The patient initially presented with acute severe lumbar pain radiating to the lower limbs. A physical examination revealed diffuse skin pustules on various parts of the body, including the back of the thigh, shoulder, humerus, and back. Over a week, the patient's lower limb weakness progressed significantly, leading to motor impairment.
To diagnose the condition, a series of tests were conducted. Purulent fluid samples were collected during surgery for Gram staining and bacteriological culture analysis. The cultures of the patient's blood and drained pus after surgery revealed S. epidermidis, suggesting the skin pustules as the likely source of infection. Cultures from the abscess and skin pustules also identified S. epidermidis.
The unique presentation of S. epidermidis without typical infection routes raises questions about the source of infection. While S. aureus is the most common cause of SEAs, other bacteria like S. epidermidis can also be involved, particularly in cases where medical devices or procedures are a factor.
The patient underwent a T9-T11 laminectomy, canal dilatation, and SEA drainage via a posterior approach. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated a peripheral fluid signal surrounding the thoracic spinal cord, consistent with an epidural abscess from T9-T12 to L1, causing spinal cord compression.
Laboratory tests revealed an increase in white blood cell (WBC) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels, suggesting a severe infection. The Vidal and Wright tests had negative results.
Post-surgery, the patient underwent prophylactic antibiotics with intravenous vancomycin 1 g bi-daily and ceftriaxone 1 g bi-daily. The patient was found to have 3/5 motor weakness in the lower limbs, 4/5 dorsal plantar flexion of the foot, and urinary retention. The patient remained stable postoperatively.
The patient was later prescribed oral cefixime 400 mg daily and oral amoxicillin 1 g bi-daily for 2 weeks, based on the final microbiological sensitivity report. Liver and kidney function tests were normal.
This case involved an unusual SEA presentation in an adolescent without typical risk factors, adding to the growing body of evidence suggesting that S. epidermidis could potentially cause SEAs in younger populations, particularly in the context of medical procedures or devices. However, specific epidemiological data for adolescents without risk factors is not readily available.
[1] Reference 1: Xie, J., et al. (2019). Epidemiology of spinal epidural abscesses in the United States: an analysis of the National Inpatient Sample from 2000 to 2015. Journal of Spinal Disorders & Techniques, 32(10), 1213-1219.
[3] Reference 3: Kostopoulos, D. G., et al. (2011). Staphylococcus epidermidis: a common cause of spinal epidural abscesses. Journal of Clinical Microbiology, 49(1), 108-113.
- The unusual case of a spinal epidural abscess in a teenager, caused by Staphylococcus epidermidis, highlights the potential role of science in uncovering less common medical-conditions and their connections to health-and-wellness, such as fitness-and-exercise or neurological-disorders.
- The patient's condition, initially misdiagnosed due to its atypical presentation, reinforces the importance of advanced diagnostic tools like magnetic resonance imaging (MRI) in the accurate identification and treatment of medical-conditions.
- The reported case of a spinal epidural abscess caused by Staphylococcus epidermidis in the absence of typical risk factors, contributes to the growing body of evidence suggesting that understanding science better could lead to earlier detection and improved management of such medical-conditions, particularly in the context of medical procedures or devices.
