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Case Reports
. 2018 Mar 13;18(1):16.
doi: 10.1186/s12893-018-0350-2.

Lumbar spine epidural abscess and facet joint septic arthritis due to Streptococcus agalactiae: a case report

Costansia Bureta  1   2 , Hiroyuki Tominaga  3 , Takuya Yamamoto  3 , Takao Setoguchi  4 , Hideki Kawamura  5 , Satoshi Nagano  3 , Ichiro Kawamura  3 , Masahiko Abematsu  3 , Hironori Kakoi  3 , Yasuhiro Ishidou  6 , Setsuro Komiya  3
Affiliations
Case Reports

Lumbar spine epidural abscess and facet joint septic arthritis due to Streptococcus agalactiae: a case report

Costansia Bureta et al. BMC Surg. .

Abstract

Background: Here we report a rare case of lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae, which had spread to the iliopsoas muscles, leading to urine retention.

Case presentation: A 68-year-old woman with low back pain experienced a sudden onset of bilateral lower limb weakness, it was followed 14 days later by urine retention. At consultation, magnetic resonance imaging and identification of serum β-hemolytic streptococci provided a diagnosis of Streptococcus agalactiae infection. She was started on antibiotics. Despite diminishing signs of inflammation, preoperative MRI showed an epidural mass at T12-L4 compressing the cord and involving the paravertebral muscles as well. Group B beta-hemolytic streptococci were detected in both urine and blood. Because of bilateral lower limb weakness and urine retention, T12-L4 hemilaminectomy was performed. The L3/L4 intertransverse ligament resected and abscess drained. Histopathology revealed that inflammatory cells had invaded the facet joint. Group B beta-hemolytic streptococci were identified, confirming the diagnosis. The patient continued with the antibiotics postoperatively, and her health rapidly improved.

Conclusion: Lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae is a clinical emergency, with significant morbidity and mortality especially with delayed diagnosis. A delay in both diagnosis and aggressive treatment can lead to not only severe neurological deficit but also to septicaemia, multiorgan failure, and even death.

Keywords: Antibiotic administration; Facet joint septic arthritis; Hemilaminectomy; Spinal epidural abscess; Streptococcus agalactiae; Urine retention.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
T2-weighted magnetic resonance imaging (MRI) of an abscess in the L3/4 epidural space and paravertebral muscle at the initial diagnosis in our hospital. a Sagittal view. b Axial view
Fig. 2
Fig. 2
T1-weighted MRI with gadolinium enhancement at the L3/4 level. Two weeks after lumbago onset, the mass (enhanced at the edge) had spread widely to iliopsoas muscles, paraspinal muscles, and the epidural space. a Sagittal view. b Axial view
Fig. 3
Fig. 3
L3/4 facet joint parcel was torn. A white abscess is apparent in the paraspinal muscle. Findings were similar in the iliopsoas muscle and epidural abscess
Fig. 4
Fig. 4
a Note the streptococci being engulfed by leukocytes. b Pathology examination shows inflammatory cells in bone tissue of the L3/4 facet
Fig. 5
Fig. 5
Lateral XP image (a) Flexion (b) Extension of the lumbar region 15 months after surgery. Note that there was no instability of the lumbar spine
Fig. 6
Fig. 6
Sagittal view of T1-weighted (a) and T2-weighted (b) MRI image and a T2- weighted image at the L3/L4 level 47 days after surgery. Note that the abscess has disappeared
See this image and copyright information in PMC

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