SHM Converge Scientific Abstract ePoster Gallery-Group a Spinal Epidural Abscess in Covid Infection

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This case report describes a rare and severe spinal epidural abscess (SEA) in a 42-year-old woman with no typical SEA risk factors, but with incidental COVID-19 infection. SEA is a dangerous infection in the space between the dura and vertebrae that often presents nonspecifically, commonly with back pain and fever, and can rapidly progress to paralysis or sepsis if diagnosis is delayed.  <br /><br />The patient initially came in with two days of fever, urinary symptoms, back pain, body aches, and poor appetite. She had leukocytosis and pyuria, so she was started on ceftriaxone for presumed urinary tract infection. The following day, she developed lethargy, neck stiffness, and rapidly worsening weakness that progressed from the lower extremities to the distal upper extremities. MRI of the cervical, thoracic, and lumbar spine showed a large dorsal cervicothoracic epidural abscess extending from C4 to T3 with spinal cord compression at C4. She underwent urgent C3-T2 laminectomies and received six weeks of ceftriaxone. Surgical cultures grew beta-hemolytic Group A Streptococcus, while blood cultures were negative.  <br /><br />This is notable because Group A Streptococcus is an uncommon cause of SEA in adults. The authors also highlight the possible association between COVID-19 and SEA, suggesting that COVID-related immune dysfunction, nosocomial superinfection, or endothelial injury may increase susceptibility. Despite surgery and antibiotics, the patient remained paraplegic one week later and only partially improved after three months of intensive rehabilitation.  <br /><br />The report emphasizes that SEA should be considered in any patient with fever and back pain, even without neurological deficits, because delayed diagnosis can lead to irreversible injury and poor outcomes.

Asset Subtitle

Hafsa Majeed

Meta Tag

Author List Anh Nguyen, Hafsa Majeed, Julie Kanevsky, Maurice Policar, Miriam Frisch, Nuzhat Batool

Category Clinical Vignettes

Concept Spinal Epidural Abscess

Concept Magnetic Resonance Imaging

Concept Clinical Presentation

Concept Diagnostic Evaluation

Concept Spinal Cord Compression

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai

Presenting Author Hafsa Majeed

Track Adult

Keywords

spinal epidural abscess

SEA

COVID-19 infection

Group A Streptococcus

cervicothoracic abscess

spinal cord compression

laminectomy

fever and back pain

paraplegia

urinary tract infection

Spinal Epidural Abscess

Magnetic Resonance Imaging

Clinical Presentation

Diagnostic Evaluation

Spinal Cord Compression