Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 11, Number 12, December 2020, pages 417-425


Disseminated Spinal Epidural Abscess in an Immunocompetent Individual: A Case Report and Review of the Literature

Figures

Figure 1.
Figure 1. Magnetic resonance imaging T2-weighted image in thoracic vertebrae. (a) Sagittal imaging on admission. A 0.5-mm-thick layer of spinal epidural fluid in the posterior epidural space in the whole thoracic region of the spinal cord, confirming a compressed epidural space (red arrow). (b) Axial imaging on admission. Similar findings to (a) are confirmed (red arrow). (c) Sagittal imaging, 30 days into antibiotics treatment. Findings in (a) have disappeared. (d) Axial imaging, 30 days into antibiotics treatment. Thickness of spinal epidural fluid in the posterior epidural space is reduced, and compression of the epidural space has improved.
Figure 2.
Figure 2. Magnetic resonance imaging T2-weighted image in lumber and sacral vertebrae. (a) Sagittal imaging on admission. A 0.5-mm-thick layer of spinal epidural fluid in the anterior epidural space from the L5 to S2 vertebral body level region, confirming a compressed epidural space (red arrow). (b) Axial imaging on admission. Similar findings to (a) are not confirmed. (c) Sagittal imaging, 30 days into antibiotics treatment. Findings in (a) have disappeared. (d) Axial imaging, 30 days into antibiotics treatment. Findings in (a) are not confirmed.

Table

Table 1. Routine Laboratory Examination on Admission
 
Parameter (units)Measured valueNormal value
CLEIA: chemiluminescent enzyme immunoassay; PR3: proteinase 3; MPO: myeloperoxidase; Ig: immunoglobulin.
Blood
  White blood cell (103/µL)13.53.8 - 8.5
    Neutrophil (%)81.648 - 61
    Lymphocyte (%)10.425 - 45
    Monocyte (%)7.94 - 7
    Eosinophil (%)01 - 5
    Basophil (%)0.10 - 1
  Red blood cell (106/µL)4.763.78 - 4.97
  Platelet (103/µL)222131 - 365
  Aspartate transaminase (IU/L)2012 - 31
  Alanine aminotransferase (IU/L)188 - 40
  Lactic acid dehydrogenase (IU/L)134110 - 210
  Gamma-glutamyl transpeptidase (IU/L)299 - 49
  Total bilirubin (mg/dL)0.390.3 - 1.2
  Total protein (g/dL)6.96.7 - 8.3
  Albumin (g/dL)4.23.9 - 4.9
  Creatine kinase (IU/L)3450 - 170
  Blood urea nitrogen (mg/dL)5.58 - 22
  Creatinine (mg/dL)0.810.4 - 0.8
  Amylase (IU/L)10039 - 134
  Sodium (mEq/L)138138 - 146
  Potassium (mEq/L)3.83.6 - 4.9
  Chloride (mEq/L)10599 - 109
  C-reactive protein (mg/dL)10.980 - 0.4
  Procalcitonin (ng/mL)0.180 - 0.5
  Hepatitis B surface antigen/CLEIA(-)(-)
  Hepatitis C virus antibody(-)(-)
  Treponema pallidum antibody(-)(-)
  Rapid plasma reagin card agglutination test(-)(-)
  Rheumatoid factor (IU/mL)00 - 15
  Thyroid-stimulating hormone (µIU/mL)1.9330.541 - 4.261
  Triiodothyronine (pg/mL)2.332.39 - 4.06
  Thyroxin (ng/dL)1.070.72 - 1.52
  Activated partial thromboplastin time (s)37.526.1 - 35.6
  Prothrombin time (international normalized ratio)1.230.8 - 1.18
  Fibrinogen (mg/L)677200 - 400
  Antithrombin III (%)9880 - 120
  Fibrin degradation products (µg/mL)4.90 - 10
  D-dimer (µg/mL)1.680 - 1
  Erythrocyte sedimentation rate (mm/h)643 - 15
  Erythrocyte sedimentation rate (mm/2 h)1030 - 43
  Human immunodeficiency virus-1, 2 antigen/antibody(-)(-)
  IgE (IU/mL)1040 - 170
  PR3-antineutrophil cytoplasmic antibody(-)(-)
  MPO-antineutrophil cytoplasmic antibody(-)(-)
  Soluble interleukin-2 receptor (U/mL)409122 - 496
  Antinuclear antibody (times)< 40< 40
  Anti-cardiolipin IgG (U/mL)30 - 10
  Lupus anticoagulant/PLI0.810 - 1.16
Urine
  Urobilinogen(-)(-)
  Occult blood reaction(-)(-)
  Protein(-)(-)
  Sugar(-)(-)
  pH85 - 7.5
  Ketone body(-)(-)
  Bilirubin(-)(-)
  Nitrite(-)(-)
  White blood cells(-)(-)
  Streptococcus pneumoniae(-)(-)
  Legionella pneumoniae(-)(-)
  Pregnant reaction(-)
Flu A(-)(-)
Flu B(-)(-)
Mycoplasma pneumoniae antigen(-)(-)
Cerebrospinal fluid
  Red blood cell number (/µL)0
  Cell number (/µL)2
  Mononuclear cell (%)50
  Polymorphonuclear cell (%)50
  Pandy reaction(-)
  Protein (mg/dL)34.1
  Sugar (mg/dL)57
  Potassium (mEq/L)2.6
  Chloride (mEq/L)122.9