Klebsiella Discitis in a 15-Year-Old Male Diagnosed With Plasma Microbial Cell-Free DNA Next-Generation Sequencing Test: A Case Report

Abstract

Spinal discitis (SD) is a rare condition, particularly in the pediatric population. The course of SD may be acute or chronic, and the non-specificity of symptoms leads to great delays in diagnosis. The most commonly isolated causative organism is Staphylococcus aureus whereas gram-negative infections are hardly ever reported in the literature. Comorbidities that increase the risk of bacteremia such as diabetes, chronic kidney disease, HIV, and cancer are major risk factors for SD. Hereby, we present an atypical case of SD in a previously healthy 15-year-old male with an unusual organism, Klebsiella aerogenes, diagnosed by plasma microbial cell-free DNA with negative blood cultures. The clinical course was complicated by antibiotic resistance and subsequent development of a ventral epidural abscess requiring readmission followed by surgical drainage of the abscess with a prolonged course of antibiotics.

Keywords: epidural abscess; klebsiella aerogenes; neurosurgery; pediatric discitis; spinal infections.

Figure 1. Contrast-enhanced CT scan of the abdomen/pelvis. Axial image at L5-S1 also shows the enhancement without evidence of paraspinous mass, fluid, or abnormal enhancement.

Figure 2. T1 fat-saturated contrast-enhanced MRI of the lumbar spine. Axial image at L5-S1 level demonstrates mild enhancement of the anterior aspect of the thecal sac.

Figure 3. T1 fat-saturated contrast-enhanced MRI of the lumbar spine. Axial image at L5-S1 level demonstrates worse enhancement of the anterior aspect of the thecal sac and extension of enhancement along the left side of the vertebral body. The nerve roots are displaced posteriorly by epidural phlegmon.

Figure 4. MRI lumbar spine T1 fat-saturated with IV contrast. Axial post-contrast image shows bright epidural enhancement surrounding a low signal intensity fluid collection that extends into the left paraspinous muscles and the posterior subcutaneous tissues.

Figure 5. T1 fat-saturated contrast-enhanced MRI of the lumbar spine. Axial view at L5-S1 demonstrates no abnormal enhancement of the bone, paraspinal soft tissues, thecal sac, or epidural region. All fluid collections had resolved. No displacement of the thecal sac was seen.