一例罕见的单形链球菌硬膜外脓肿病例,需要进行神经外科减压术

Saba Rentia, Jayanidhi Kedda, Peter Harris, Chase Harrison Foster, Michael Rosner
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引用次数: 0

摘要

单形链球菌是鼠咬热的主要致病菌,鼠咬热是一种通过咬伤、抓伤或接触排泄物与老鼠接触而传播的传染病。在本报告之前,仅有两例脊髓硬膜外脓肿(SEA)病例是由单形杆菌感染引起的。一名 76 岁的男性因双侧肩背部疼痛、上肢无力、左臀部疼痛和左手拇指疼痛到急诊科就诊。他否认最近接触过宠物或动物,初步检查也未发现感染源。颈椎的增强磁共振成像显示,患者患有C6-7椎间盘炎/骨骨髓炎和相关的腹侧SEA,以及C2椎体和C5-6终板的椎间盘炎/骨骨髓炎。随后,患者接受了 C3-7 椎板切除术,术后静脉注射头孢曲松 6 周,脓肿完全消退。血液化验显示患者体内存在单形孢子菌,患者将其归因于工作场所可能接触到的老鼠。神经外科医生应在 SEA 的鉴别诊断中考虑这种罕见病原体,以便及早发现、诊断和手术干预,最终改善患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A rare case of Streptobacillus moniliformis epidural abscess requiring neurosurgical decompression
Streptobacillus moniliformis is the primary causative agent of rat bite fever, an infectious disease transmitted through contact with rats through bites, scratches, or exposure to excrement. Before this report, only two instances of spinal epidural abscess (SEA) due to S. moniliformis infection have been documented. We present the case of a 76-year-old male who developed a cervical SEA secondary to S. moniliformis infection, requiring neurosurgical decompression of the spinal cord. A 76-year-old male presented to the emergency department with bilateral shoulder and back pain, upper extremity weakness, left hip pain, and left thumb pain. He denied any recent exposure to pets or animals, and the initial workup did not yield the source of the infection. Enhanced magnetic resonance imaging of the cervical spine demonstrated C6–7 discitis/osteomyelitis and an associated ventral SEA, as well as discitis/osteomyelitis of the C2 vertebral body and C5–6 endplates. Subsequently, the patient underwent a C3–7 laminectomy and received a 6-week postoperative course of intravenous ceftriaxone, resulting in complete resolution of the abscess. Blood tests revealed the presence of S. moniliformis, which the patient attributed to potential rat exposure at his workplace. Identification and diagnosis of S. moniliformis infection requires a high index of suspicion. Neurosurgeons should consider this rare pathogen in the differential diagnosis of SEA to facilitate early detection, diagnosis, and surgical intervention, ultimately improving patient outcomes.
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