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Intramedullary spinal cord abscess involving Actinomyces and Streptococcus: a case report and literature review

Spinal Cord Series and Cases volume 10, Article number: 6 (2024) Cite this article

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Abstract

Introduction

Intramedullary spinal cord abscesses (ISCA) are rare and caused by central nervous system infections. Although polymicrobial infections are rarely seen in ISCAs, isolation of the causative pathogen is important for treatment. Here, we describe a very rare case of ISCA resulting from a mixed Streptococcus and Actinomyces infection.

Case presentation

An 82-year-old man presented with acute posterior cervical pain and progressive quadriplegia. Radiological investigations revealed a mass lesion showing marginal enhancement at the level of the C3-4 vertebrae. Microsurgical drainage was performed, and Streptococcus and Actinomyces were identified as causative agents. Subsequent antibiotic treatment was noted to be beneficial to the patient.

Discussion

This case suggests that mixed infection can develop into ISCA depending on the causative agents such as Actinomyces. Prompt pathogen-directed antibacterial therapy is required for ISCA treatment.

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Fig. 1: Magnetic resonance imaging at the time of admission.
Fig. 2: Intraoperative photographs.
Fig. 3: Histopathological examinations.
Fig. 4: Magnetic resonance imaging during the postoperative period.

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Data availability

The authors state that data pertaining to this case report will be made available upon request.

References

  1. Chan CT, Gold WL. Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis. 1998;27:619–26.

    Article  CAS  PubMed  Google Scholar 

  2. Sinha P, Parekh T, Pal D. Intramedullary abscess of the upper cervical spinal cord. Unusual presentation and dilemmas of management: case report. Clin Neurol Neurosurg. 2013;115:1845–50.

    Article  PubMed  Google Scholar 

  3. Ravindra N, Sadashiva N, Mahadevan A, Bhat DI, Saini J. Central nervous system actinomycosis—a clinicoradiologic and histopathologic analysis. World Neurosurg. 2018;116:e362–70.

    Article  PubMed  Google Scholar 

  4. Kirshblum S, Snider B, Rupp R, Read MS. International Standards Committee of ASIA and ISCoS. Updates of the international standards for neurologic classification of spinal cord injury: 2015 and 2019. Phys Med Rehabil Clin N. Am. 2020;31:319–30.

    Article  PubMed  Google Scholar 

  5. Akimoto T, Hirose S, Mizoguchi T, Yokota Y, Hara M, Ishihara M, et al. Ruptured long intramedullary spinal cord abscess successfully treated with antibiotic treatment. J Clin Neurosci. 2020;82:249–51.

    Article  CAS  PubMed  Google Scholar 

  6. Cerecedo-Lopez CD, Bernstock JD, Dmytriw AA, Chen JA, Chalif JI, Gupta S, et al. Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature. BMC Infect Dis. 2022;22:141.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bakhsheshian J, Kim PE, Attenello FJ. Intramedullary cervical spinal cord abscess. World Neurosurg. 2017;106:1049.e1–e2.

    Article  PubMed  Google Scholar 

  8. Keefe P, Das JM, Al-Dhahir MA. Spinal Cord Abscess, in StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC., 2022.

  9. Duvignaud A, Ribeiro E, Moynet D, Longy-Boursier M, Malvy D. Cervical spondylitis and spinal abscess due to Actinomyces meyeri. Braz J Infect Dis. 2014;18:106–9.

    Article  PubMed  Google Scholar 

  10. Honda H, Bankowski MJ, Kajioka EH, Chokrungvaranon N, Kim W, Gallacher ST. Thoracic vertebral actinomycosis: actinomyces Israelii and Fusobacterium nucleatum. J Clin Microbiol. 2008;46:2009–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. David C, Brasme L, Peruzzi P, Bertault R, Vinsonneau M, Ingrand D. Intramedullary abscess of the spinal cord in a patient with a right-to-left shunt: case report. Clin Infect Dis. 1997;24:89–90.

    Article  CAS  PubMed  Google Scholar 

  12. Simon JK, Lazareff JA, Diament MJ, Kennedy WA. Intramedullary abscess of the spinal cord in children: a case report and review of the literature. Pediatr Infect Dis J. 2003;22:186–92.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Shunsuke Nakamura, Hiroya Shimauchi-Ohtaki, Fumiaki Honda & Yuhei Yoshimoto

  2. Infection Control and Prevention Center, Gunma University Hospital, Maebashi, Gunma, Japan

    Yutaka Tokue

Authors
  1. Shunsuke Nakamura
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  2. Hiroya Shimauchi-Ohtaki
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  3. Fumiaki Honda
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  4. Yutaka Tokue
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  5. Yuhei Yoshimoto
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Contributions

SN and HS were responsible for writing the report, conducting the literature search, extracting and analyzing data, interpreting results, and updating reference lists. FH was responsible for extracting and analyzing data and interpreting results. YT and YY provided feedback on the report.

Corresponding author

Correspondence to Hiroya Shimauchi-Ohtaki.

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As this is a case report, informed consent was obtained from the patient for publication, and institutional ethical review was deemed unnecessary.

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Nakamura, S., Shimauchi-Ohtaki, H., Honda, F. et al. Intramedullary spinal cord abscess involving Actinomyces and Streptococcus: a case report and literature review. Spinal Cord Ser Cases 10, 6 (2024). https://doi.org/10.1038/s41394-024-00618-5

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  • DOI: https://doi.org/10.1038/s41394-024-00618-5

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