Treatment of Pasteurella multocida Cervical Epidural Abscess

Abstract

A 51-year-old left-handed Caucasian female with no significant medical history presented with a two-week history of severe neck pain and bilateral upper limb weakness. Neurological examination revealed weakness and altered sensation in the C5-T1 distribution bilaterally, more severe on the left with Medical Research Council's scale (MRC scale) of muscle power grade 3/5 and 4/5 on the right with upper motor neuron signs. Short-TI Inversion Recovery (STIR) and T2 weighted MRI imaging revealed increased signal at the C6-7 disc representing discitis, as well an anterior epidural collection from C5 to C7, with associated cord compression. The patient underwent an emergency anterior cervical corpectomy of C6, drainage of the epidural purulent collection, and insertion of a cage and plate. Some tissue and pus samples were sent to the microbiology laboratory for analysis, and the organism Pasteurella multocida was identified on all samples. The patient clinically and biochemically improved with operative management and a prolonged course of intravenous ceftriaxone. A peripherally inserted central catheter (PICC) line was placed and the patient was discharged on eight weeks of intravenous ceftriaxone and ongoing physical therapy.

Keywords: cervical spine; epidural abscess; microbiology; orthopaedics surgery; pasteurella multocida.

Figure 1. Sagittal T2 MRI showing a ventral C5-C6-C7 cervical epidural mass causing cord compression and displacement.

Figure 2. Lateral radiograph of the cervical spine demonstrating a C6 corpectomy, expandable cage, and plate fixed from C5 to C7, four weeks postoperatively.

Figure 3. Blood agar plate showing non-hemolytic grey translucent colonies.