He Jianfeng, Xie Jie, Niu Chen
Department of Radiology, Guihang 300 Hospital Affiliated to Zunyi Medical University, Guiyang, China.
Department of Neurology, Guihang 300 Hospital Affiliated to Zunyi Medical University, 420 Huanghe Road, Guiyang, 550027, China.
Heliyon. 2024 Nov 14;10(22):e40393. doi: 10.1016/j.heliyon.2024.e40393. eCollection 2024 Nov 30.
Intramedullary spinal cord abscess (ISCA) is a rare and serious condition with high disability and mortality rates. is known for its aggressive and disseminated abscess formation. However, ISCA caused by has only been reported in two cases. Additionally, there have been no documented instances of invasive syndrome with abscesses in the brain, intramedullary spinal cord, renal subcapsular, and prostate simultaneously.
A 58-year-old man with poorly controlled type 2 diabetes presented with a 4-day history of fever, fatigue and loss of appetite, accompanied by urinary frequency and urgency. A contrast computed tomography (CT) scan of the chest, abdomen, and pelvis revealed abscesses in multiple organs including the lung, renal subcapsular, and prostate. Over following 8 days, the patient experienced with urodynia, back pain, dysuria and bilateral lower limb weakness. Subsequent magnetic resonance imaging (MRI) of the brain and spinal also showed multiple abscesses. Cultures of blood, urine, and pus from the prostate abscesses grew , characterized by the hypermucoviscous phenotype, as confirmed by the string test. After treatment with imipenem/cilastatin, amikacin, and a period of rehabilitation, the patient was discharged in good health.
This case emphasizes the need to consider ISCA in disseminated hmKp infection patients with back pain and neurological deficits. Timely identification and antibiotic treatment may obviate the need for surgical intervention.
脊髓内脓肿（ISCA）是一种罕见且严重的疾病，致残率和死亡率很高。它以侵袭性和播散性脓肿形成为特征。然而，由[具体病原体未提及]引起的ISCA仅报道过两例。此外，尚无同时在脑、脊髓内、肾被膜下和前列腺出现脓肿的[具体病原体未提及]侵袭综合征的文献记载病例。
一名58岁2型糖尿病控制不佳的男性，出现发热、乏力和食欲不振4天，伴有尿频和尿急。胸部、腹部和骨盆的增强计算机断层扫描（CT）显示包括肺、肾被膜下和前列腺在内的多个器官有脓肿。在接下来的8天里，患者经历了尿痛、背痛、排尿困难和双侧下肢无力。随后的脑和脊髓磁共振成像（MRI）也显示有多个脓肿。前列腺脓肿的血液、尿液和脓液培养物培养出[具体病原体未提及]，经拉丝试验证实为高黏液型表型。经亚胺培南/西司他丁、阿米卡星治疗及一段时间的康复治疗后，患者康复出院。
本病例强调在伴有背痛和神经功能缺损的播散性高黏液型肺炎克雷伯菌感染患者中需要考虑ISCA。及时识别和抗生素治疗可能无需手术干预。
