Treatment of a Staphylococcus lugdunensis cervical epidural abscess

BMJ Case Rep. 2019 Mar 20;12(3):e227449. doi: 10.1136/bcr-2018-227449.

Abstract

First reported in 1988, Staphylococcus lugdunensis is a virulent coagulase-negative Staphylococcus species often associated with endocarditis. This is the first case report describing this infection in the cervical spine. A 58-year-old, left-handed Caucasian woman with no significant medical history presented with neck and left arm pain. Neurological examination revealed mild left deltoid 4/5 weakness and myelopathy. She was found to have an epidural cervical spinal cord mass that was causing severe cord compression and underwent partial anterior cervical decompression of the mass. On entering what was believed to be the mass, yellow-tinged fluid was encountered. An abscess was immediately suspected, so the dura was not entered. The specimen sent for culture was identified a day later as S. lugdunensis A two-dimensional echocardiogram was negative for vegetations. A peripherally inserted central catheter line was placed and the patient discharged on 6 weeks of physical therapy and 6-8 weeks of intravenous cefazolin.

Keywords: bone and joint infections; infections; pathology.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Cefazolin / administration & dosage*
  • Cervical Cord / diagnostic imaging
  • Epidural Abscess / complications*
  • Epidural Abscess / diagnostic imaging
  • Epidural Abscess / drug therapy
  • Epidural Abscess / microbiology
  • Epidural Space / diagnostic imaging
  • Female
  • Humans
  • Middle Aged
  • Rifampin / administration & dosage*
  • Spinal Cord Compression / diagnostic imaging
  • Spinal Cord Compression / etiology*
  • Staphylococcal Infections / blood
  • Staphylococcal Infections / complications*
  • Staphylococcal Infections / drug therapy
  • Staphylococcus lugdunensis / isolation & purification

Substances

  • Anti-Bacterial Agents
  • Cefazolin
  • Rifampin