[Prevertebral abscesses with a protracted insidious clinical course and subsequent lethal, acute pyogenic meningitis and septic shock].

This report concerns a 66-year-old man suffering from prevertebral abscesses with a protracted insidious clinical course and subsequent lethal and acute pyogenic meningitis. The patient had a three-month history of mild neck pain, and died as a result of septic shock due to staphylococcus aureus (methicillin susceptible) infection two days after admission to the hospital. At autopsy, abscesses encapsulated by fibrous connective tissue were found on the ventral surfaces of the cervical and thoracic regions of the spine. The prevertebral abscess on the upper cervical region was organized with dense fibrous tissue and contained a small number of inflammatory cells. On the other hand, the prevertebral abscess on the thoracic region was purulent and contained numerous inflammatory cells, macrophages and gram-positive cocci. Pyogenic spondylitis and discitis accompanying the prevertebral abscesses were multiple and widespread. These features suggested that the abscesses developed initially on the cervical region, extended caudally through the prevertebral space, directly involving the corpus vertebrae and discs, and ultimately caused sepsis. It is important to note that prevertebral abscesses can exhibit a protracted clinical course with only mild symptom such as minor neck pain and then manifest abruptly as acute meningitis and sepsis.