Streptococcus gallolyticus-related spinal epidural abscess

Abstract

Spinal epidural abscess (SEA) is a surgical emergency if it causes paraplegia. Staphylococcus aureus and streptococci are the most common causes. Streptococcus gallolyticus has been reported to cause SEA only on three occasions earlier-all were associated with endocarditis or colonic malignancy. We report an older woman with diabetic ketoacidosis who presented with poorly localised back pain, fever and altered sensorium. Her lumbar puncture revealed frank pus, and MRI showed an SEA. She could not be weaned from mechanical ventilation post-surgical decompression, and she succumbed to ventilator-associated pneumonia. A triad of fever, back pain and neurological deficit should lead one to consider intraspinal suppuration. This report is the first S. gallolyticus-related SEA from India and the first in literature that was not associated with either endocarditis or colonic malignancy.

Keywords: Diabetes; Infection (neurology); Meningitis.