Cervical Spinal Epidural Abscess From Haemophilus influenzae in an Adult: A Case Report

Abstract

Pyogenic spinal infections due to Haemophilus influenzae (H. influenzae) are rare. After a search of the literature, we deemed our case to be the first description of spinal epidural abscess (SEA) from H. influenzae. This is a 74-year-old female patient with a history of diabetes who presented to the emergency department with fever and persistent paracervical pain after being initially diagnosed with viral sinusitis two days prior. The examination was negative for neurologic deficits. She was admitted for possible meningitis versus intramuscular abscess due to cerebrospinal fluid pleocytosis and CT imaging findings. However, an MRI obtained during the patient's admission revealed a multi-level cervical SEA, likely from an invasive H. influenzae infection, and the patient underwent evacuation surgery with a good outcome. Epidural abscesses are rarely present in isolation in the cervical region and can be mistaken for other more common infectious and non-infectious causes of neck pain on initial presentation and even as diagnostic work-up progresses. However, there is significant morbidity if diagnosis via advanced imaging and surgical treatment is delayed. We aim to present the first reported case of SEA from H. influenzae and increase awareness of this atypical presentation of a rare yet invasive disease.

Keywords: cervical pain; haemophilus influenzae; infectious disease; neck pain; neurologic emergency; pyogenic spinal infection; spinal epidural abscess.

Figure 1. CT with intravenous contrast image of soft tissue of the neck (axial view)

Rim-enhancing lesion measuring 8 mm in the left longus musculature at the C1-C2 level with associated retropharyngeal edema (yellow arrow). CT: computed tomography

Figure 2. MRI T2-weighted image of the cervical spine (sagittal view)

Rim-enhancing collection involving the dorsal epidural space, spanning from C2 level to inferior T1 level with mass effect on the thecal sac and cord most severely within the lower cervical spine (yellow arrow). Rim-enhancing lesion centered within the left longus coli musculature and associated extensive edema of the longus coli muscle and within the retropharyngeal space (blue arrow). MRI: magnetic resonance imaging