Cervical spine infection arising from chronic paronychia: A case report and review of literature

Abstract

Background: Cervical spine pyogenic infection (CSPI) is a rare and challenging form of spinal infection that is typically caused by pyogenic bacteria and primarily affects the cervical vertebral bodies and surrounding tissues. Given its nonspecific symptoms, such as fever and neck pain, early diagnosis is crucial to prevent severe complications, including spinal cord injury. We report a previously unreported case of acute CSPI arising from chronic paronychia, exploring its diagnostic and therapeutic challenges through a review of the current literature.

Case summary: The presented case involved a 15-year-old man with CSPI caused by Staphylococcus aureus, which led to complications including bacteremia and a paronychia-associated abscess. Acute pyogenic infection was initially diagnosed by typical symptoms and blood culture. Fever improved after antibiotic treatment while developing progressive limbs dysfunction. Six days after admission, the patient underwent anterior cervical debridement + autogenous iliac bone graft fusion + plate internal fixation and received 12 weeks of antibiotic treatment after the operation. Re-examination 3 years postoperatively showed that the patient had stable cervical fixation, no significant neck pain or upper limb abnormalities, and normal urinary function.

Conclusion: Early imaging findings, laboratory markers, and timely antibiotic treatment are crucial for CSPI management, preventing complications and facilitating recovery.

Keywords: Antibacterial treatment; Case report; Cervical spine; Paronychia; Pyogenic infection; Surgery.

Figure 1

Admission X-ray and computed tomography. A: Anterior-posterior X-ray image of cervical vertebra; B: Lateral X-ray view of cervical vertebra; C: Coronal computed tomography (CT) view of cervical vertebra; D: Sagittal CT view of cervical vertebra; E: Axial CT view of cervical vertebra (level C5).

Figure 2

Preoperative magnetic resonance imaging. A: Sagittal T2-weighted magnetic resonance imaging (MRI) of cervical vertebra; B: Sagittal T2-weighted MRI with fat suppression; C: Axial T2-weighted MRI of cervical vertebra (level C5); D: Axial T2-weighted MRI with fat suppression of cervical vertebra (level C5).

Figure 3

Appearance of the big toe and postoperative pathology of C5 vertebra. A: Onychocryptosis and paronychia of the big toe (left); B: Onychocryptosis and paronychia of the big toe (right); C: Surgical specimen from C5 vertebra; D: Histological examination (hematoxylin and eosin staining, 40 × under microscope) reveals purulent necrosis and inflammatory infiltrate in the bone trabeculae of C5 vertebra.

Figure 4

Postoperative follow-up imaging. A: Anterior-posterior X-ray image of cervical vertebra (2 days after operation); B: Lateral X-ray view of cervical vertebra (2 days after operation); C: Sagittal T1-weighted magnetic resonance imaging (MRI) of cervical vertebra (12 days after operation); D: Sagittal T2-weighted MRI with fat suppression (12 days after operation); E: Axial T2-weighted MRI of cervical vertebra (level C5) (12 days after operation); F and G: X-ray of cervical vertebra (3 months after operation); H: Coronal computed tomography (CT) view of cervical vertebra (3 months after operation); I: Sagittal CT view of cervical vertebra (3 months after operation); J: Axial CT of cervical vertebra (level C4) (3 months after operation); K and L: X-ray of cervical vertebra (12 months after operation); M: Coronal CT view of cervical vertebra; N: Sagittal CT view of cervical vertebra (12 months after operation); O: Axial CT of cervical vertebra (level C4) (12 months after operation); P and Q: X-ray of cervical vertebra (24 months after operation); R: Coronal CT view of cervical vertebra (24 months after operation); S: Sagittal CT view of cervical vertebra (24 months after operation); T: Axial CT of cervical vertebra (level C4) (24 months after operation); U and V: X-ray of cervical vertebra (36 months after operation); W: Coronal CT view of cervical vertebra (36 months after operation); X: Sagittal CT view of cervical vertebra (36 months after operation); Y: Axial CT of cervical vertebra (level C5) (36 months after operation).