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Case Reports
. 2017 Jun;3(2):243-249.
doi: 10.21037/jss.2017.05.04.

Streptococcus intermedius: an unusual cause of spinal epidural abscess

Seba Ramhmdani  1 , Ali Bydon  1
Affiliations
Case Reports

Streptococcus intermedius: an unusual cause of spinal epidural abscess

Seba Ramhmdani et al. J Spine Surg. 2017 Jun.

Abstract

Spinal epidural abscess (SEA) following dental procedures is a rarely reported entity. Here, we present a unique case of a 74-year-old immunocompetent man who developed severe lower back pain and bilateral lower extremity weakness 4 days following two root canal procedures. Lumbar spine magnetic resonance imaging (MRI) showed several pockets of epidural abscesses extending from L1 through L5. Blood cultures grew Streptococcus intermedius, an anaerobic commensal bacterium of the normal flora of the mouth and upper airways. The patient was treated with IV penicillin for 7 days but his symptoms continued to deteriorate. A repeat MRI showed extension of the epidural abscess to T10-T11 level. The patient was emergently transferred to our hospital where he underwent bilateral decompressive laminectomy of T10 through S1 and abscess evacuation. Pus culture was positive for Streptococcus intermedius, which confirmed the diagnosis and the treatment plan. He was discharged on intravenous (IV) penicillin for 6 weeks. His symptoms improved significantly postoperatively as he retained his baseline strength in his lower extremity.

Keywords: Streptococcus intermedius; root canal; spinal epidural abscess (SEA); tooth extraction.

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Conflict of interest statement

Conflicts of Interest: Ali Bydon is a recipient of a research grant from DePuy Spine, and serves on the clinical advisory board of MedImmune, LLC.

Figures

Figure 1
Figure 1
Preoperative T2-weighted images (A) and T1-weighted images with contrast (B) show pockets of spinal epidural abscesses with arachnoidal adhesions with meningitis and enhancement of the cauda equina nerve roots. Note the chronic L5–S1 spondylolisthesis.
Figure 2
Figure 2
Postoperative T2-weighted images (A) and T1-weighted images with contrast (B) show marked improvement in the inflammation in the epidural space and around the thecal sac.
See this image and copyright information in PMC

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