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Spinal cord injury as a result of Staphylococcus aureus pyogenic spinal infection complicating infected atopic eczema: two case reports

Spinal Cord Series and Cases volume 9, Article number: 43 (2023) Cite this article

Subjects

Abstract

Introduction

Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin’s natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.

Case presentation

We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.

Discussion

We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.

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Fig. 1: MRI cervical spine.
Fig. 2: MRI lumbar spine.

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Data availability

Additional data relating to the two cases presented here are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the administrative team at the Queen Elizabeth National Spinal Injuries Unit who maintain the clinical database that was used to collate some of the data presented here.

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Authors and Affiliations

  1. Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, UK

    K. MacKay, E. J. McCaughey & M. Purcell

  2. University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, UK

    K. MacKay

  3. Neuroscience Research Australia, 139 Barker St, Sydney, NSW, 2031, Australia

    E. J. McCaughey

  4. Department of Neuroradiology, Institute of Neurological Science, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, UK

    N. Fullerton

Authors
  1. K. MacKay
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  2. E. J. McCaughey
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  3. N. Fullerton
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  4. M. Purcell
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Contributions

KM collated all data, reviewed all records and drafted the initial paper. MP helped analyse all patient records, assisted with data collation and edited a draft of the paper. EM assisted with interpreting the data and drafting the paper. NF provided images and interpretation and edited a draft of the paper. All authors approved the final version of the paper.

Corresponding author

Correspondence to M. Purcell.

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Competing interests

The authors declare no competing interests.

Ethics approval

No ethical approval was required for this case series, as both patients received standard of care. However, written informed consent was received from both patients for their data to be presented here.

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MacKay, K., McCaughey, E.J., Fullerton, N. et al. Spinal cord injury as a result of Staphylococcus aureus pyogenic spinal infection complicating infected atopic eczema: two case reports. Spinal Cord Ser Cases 9, 43 (2023). https://doi.org/10.1038/s41394-023-00599-x

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  • DOI: https://doi.org/10.1038/s41394-023-00599-x

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