The Co-occurance of Meningitis and Paraspinal Infection after Repetitive Procedural Treatment of the Spine - A Case Report -

Jong Uk Mun; Suk Joong Lee

doi:10.4184/jkss.2016.23.4.234

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Mun and Lee: The Co-occurance of Meningitis and Paraspinal Infection after Repetitive Procedural Treatment of the Spine - A Case Report -

Case Report

Journal of Korean Spine Surg 2016;23(4):234-238.

Published online: 31 December 2016

DOI: https://doi.org/10.4184/jkss.2016.23.4.234

The Co-occurance of Meningitis and Paraspinal Infection after Repetitive Procedural Treatment of the Spine - A Case Report -

Jong Uk Mun, M.D., Suk Joong Lee, M.D^∗,

Department of Orthopaedic Surgery, Changwon Gyeongsang National University School of Medicine, Gyeongsangnam-do, Korea

^∗Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea

Corresponding author: Suk Joong Lee, M.D Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea TEL: +82-53-250-7729, FAX: +82-53-250-7205 E-mail: polo4164@naver.com

Received 18 March 201622 March 2016 Accepted 6 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Case report.

Objectives

We report a case of meningitis combined with paraspinal infection in a patients who underwent numerous surgeries for and repetitive procedural treatment of the spine.

Summary of Literature Review

In patients with a history surgical and repetitive procedural treatment of the spine, one symptom of infection may be a fever with localized pain or tenderness along the spine.

Materials and Methods

A 69-year-old man was hospitalized due to pyrexia and myalgia. Eight years ago, he underwented spine surgery. After that, the patient underwent spinal intervention more than once per week in another hospital due to remaining pain. One week before his visit to the emergency room, myalgia and aggravation in the lower back arose. However, a paraspinal infection was not detected in a non-enhanced MRI. One day after admission, the patient showed signs of meningeal irritation signs and the the patient's mental state suddenly deteriorated. An emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. An enhanced MRI of the brain showed pachymeningeal enhancement. An enhanced MRI of the spine showed a small abscess formation on the left paravertebral back muscle, and bilateral psoas muscle.

Results

Serrtia marcescens was identified on blood cultures obtained upon admission. Since antibiotics were used to treat Serratia marcescens, the fever subsided, and the patient's mental status returned to normal.

Conclusions

For patients with a history of repetitive procedural treatments of the spine, a fever should be acknowledged as a symptom in meningitis or other infectious conditions.

Keywords: Paraspinal infection, Meningitis

REFERENCES

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Fig. 1.

Magnetic resonance image from another hospital did not reveal paraspineal infection, or the epidural abscess. (A) T2 weighted saggital image. (B) T2 weighted axial image at the L4/5 level.

Fig. 2.

Enhanced magnetic resonance imaging (MRI) of the spine and the brain. (A) T1 weighted enhanced saggital image. (B) T1 axial axial image at the level of the L4/5, showed small abscess formation of the left paravertebral back muscle and the bilateral psoas muscle. (C) Axial brain MRI showed pachymeningeal enhancement.

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